Trends in depression related cardiovascular mortality among adults from 1999 to 2020: a retrospective study in the United States

Background

Cardiovascular disease (CVD) and depression frequently coexist, leading to worse outcomes and higher mortality than CVD alone. Despite this impact, long-term trends in cardiovascular mortality among adults with depression remain underexplored.

Methods

We used the CDC WONDER database to obtain death certificate data from 1999 to 2020 for adults aged ≥25 years. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 population were extracted. Annual percent change (APC) and average APC (AAPC) were estimated using Joinpoint regression and compared to the general population using pairwise comparison.

Results

A total of 79,813 CVD deaths occurred in adults with depression. Mortality trends were stable until 2002 (APC: 0.14), declined significantly through 2010 (APC: -6.87), remained relatively stable from 2010 to 2018 (APC: -0.80), then rose significantly until 2020 (APC: 8.52). AAPCs differed significantly from the general population. AAMRs were consistently higher in females than males and highest among NH Whites, followed by NH Black or African Americans, Hispanics/Latinos, and NH Asian or Pacific Islanders. Regional variation in AAMRs was noted (Midwest: 2.2; West: 1.7; Northeast: 1.5; South: 1.4), with AAPCs differing from the general population in the Midwest and Northeast. AAMRs were higher in non-metropolitan (2.2) than metropolitan areas (1.6). APCs for CMRs in all analysed age groups (45–54 to 85+) differed significantly from the general population.

Conclusion

CVD mortality rates among adults with depression have risen since 2018, with disparities by sex, race, and geography. These findings underscore the need for targeted interventions to reduce mortality in this high-risk population.