Temporal trends in mortality due to coronary heart disease in Germany from 1998 to 2023.

Background: Coronary heart disease (CHD) is the leading cause of death in Germany. Comprehensive analyses of long-term trends in CHD mortality that also distinguish between acute myocardial infarction (AMI) and non-AMI-related chronic CHD are currently lacking.

Method: Age-specific and age-standardised CHD mortality rates for the period 1998 - 2023 were calculated based on data from the cause-of-death statistics of the Federal Statistical Office of Germany. Annual percentage changes (APC) and average annual percentage changes (AAPC) were estimated using joinpoint regression analysis.

Results: Between 1998 and 2023, the average annual change in age-standardised CHD mortality rates for women was -3.9 % ((-4.1) - (-3.7)) per year, compared with -3.2 % ((-3.3) - (-3.0)) for men. However, since the 2010s, the downward trend in CHD mortality has flattened, particularly among those aged 60 to 74 years. In the analysis by ICD subgroups, mortality rates for chronic CHD declined less sharply than for AMI over the entire period 1998 - 2023, especially among men.

Conclusions: The flattening of the CHD mortality trend, particularly among middle-aged adults over the last decade, and the smaller decline in chronic CHD mortality, especially among men, require further exploration in order to identify unmet needs at various levels of prevention for specific life stages. In addition, the influence of the COVID-19 pandemic on CHD mortality trends should be further investigated.