Temporal trends in heart failure and acute kidney injury-related mortality in the U.S.: a 21-year retrospective analysis of the CDC WONDER database.

Background: Heart failure (HF) and acute kidney injury (AKI) are leading contributors to morbidity and mortality in the United States, often coexisting as part of the cardiorenal syndrome. Understanding long-term mortality trends is crucial for guiding healthcare policies and interventions. This study analyses national trends in HF- and AKI-related mortality from 1999 to 2020, with a focus on age-adjusted mortality rates (AAMR) and disparities across gender, race/ethnicity, urbanization, and geographic regions.

Methods: We conducted a retrospective analysis using the CDC WONDER database, extracting mortality data for adults aged 25-85 years. HF- and AKI-related deaths were identified using ICD-10 codes. Temporal trends in AAMR were evaluated using Joinpoint regression, and subgroup analyses were performed to assess disparities.

Results: A total of 219,243 HF- and AKI-related deaths were recorded. The overall AAMR increased from 3.56 per 100,000 in 1999 to 5.30 in 2020 (AAPC: 1.52%; p < 0.001). Males had a higher AAMR than females (5.80 vs. 3.84). NH Black individuals exhibited the steepest rise in mortality, whereas NH White and Asian populations showed stabilization. Nonmetropolitan areas had higher AAMRs compared to metropolitan regions. State-level disparities revealed that North Dakota and West Virginia had the highest mortality rates, whereas Florida and Arizona had the lowest.

Conclusion: HF- and AKI-related mortality has risen significantly over the past two decades, with pronounced disparities across demographic and geographic subgroups. These findings underscore the need for targeted interventions to address healthcare inequities and improve outcomes in high-risk populations.