Trends and disparities in age, sex, ethnoracial background, and urbanization status in adult mortality due to thoracic aortic aneurysm: a retrospective nationwide study in the United States

Abstract

Introduction: Thoracic aortic aneurysms (TAA) are a significant health concern, with the true prevalence likely underestimated due to undiagnosed cases. Outcomes in TAA are influenced by factors like age, gender, and comorbidities such as hypertension. This study examines mortality trends and disparities associated with TAA in US adults. Methodology: This study analyzed death certificates from 1999 to 2020 using the CDC WONDER Database to identify TAA-related deaths in individuals aged 25 and older using ICD-10 codes I71.1 and I71.2. Age-adjusted mortality rates (AAMRs) per 1,000,000 and annual percent changes (APCs) were calculated and stratified by year, gender, age group, race/ethnicity, region, and urbanization status. Results: Between 1999 and 2020, 47,136 TAA-related deaths were reported among US adults. The AAMR decreased from 16.2 to 8.2 per 1,000,000, with a significant decline from 1999 to 2013 (APC: −5.00; 95% CI: −5.54 to −4.54; P<0.001). Older adults had the highest AAMRs at 44.6 per 1,000,000. Men had higher AAMRs than women (11.2 vs. 9). AAMRs were highest among non-Hispanic (NH) Black (11), followed by NH White (10.3), NH Asian or Pacific Islander (9.5), NH American Indian or Alaska Native (7.8), and Hispanic (5.2) populations. Non-metropolitan areas had higher AAMRs than metropolitan areas (11 vs. 9.8). Conclusions: The analysis showed a significant decline in TAA mortality since 1999, with recent stabilization. However, disparities persist, with higher AAMRs among men, older adults, NH Black adults and non-metropolitan residents, highlighting the need for targeted and equitable interventions.