Sex, Race, and Geographic Disparities in Mortality of Cardiovascular Diseases due to Thyroid Dysfunction: A 21-Year Longitudinal Analysis Using CDC WONDER Database (1999-2020).

Background: There are many prognostic factors causing morbidity and mortality due to cardiovascular diseases with ischemic heart disease, stroke, heart failure, atrial fibrillation, and Rheumatic heart disease being major contributors. Thyroid dysfunction also plays an important role in deaths caused by CVDs. The study evaluates the role of hypo and hyperthyroidism which are one of the important causes of CVDs.

Methods: Death certificates were sourced out from the database of Centers of Disease and Control (CDC) WONDER from 1999 to 2020 in United States. Various factors like sex, race, urbanization and geographical location according to state were used to calculate age adjusted mortality rates (AAMR) at a significance level of less than 0.05. Age-adjusted and crude mortality rates per 1,000,000 population were estimated. The Annual Percentage Changes (APC) were determined by using the Joinpoint Regression Program.

Results: Overall, 423,620 deaths were reported between 1999-2020, with AAMRs first increasing from 86.3 in 1999 to 92.9 in 2003, followed by a decline to 87.8 in 2004 and a gradual decrease through 2018 (APC -0.37; p < 0.05), after which a sharp rise occurred until 2020 (APC 14.25; p < 0.05). The males and females show similar mortality trends except for more deaths reported among females (106.2) than in males (59.5). In racial category, NH Whites were reported with highest AAMR (93.7), followed by American Indian or Alaskan Native (89.7), Black or African American (66.8), Hispanics (62.9), while lowest being in Asian or Pacific Islanders (40.2). Throughout the study period, non-metropolitan areas had the highest AAMR values (107.7) than medium/small metropolitan areas (96.1) with large metropolitan areas (77.1) having lowest throughout. Six states have shown the AAMR in the 90th percentile with West Virginia being highest whereas the state of Nevada has the lowest AAMR value.

Conclusion: The findings in this study show significant sex and racial disparities providing an insight of the importance regarding mortality due to thyroid dysfunction in cardiovascular diseases. Addressing risk factors and precipitating events requires targeted health policy actions in order to improve outcomes for impacted populations.