Abstract 4361991: Analyzing Trends in Mortality due to Arterial Thromboembolism in the U.S.

Abstract

Background: Thromboembolic disease is classified into 2 groups. Ischemic heart disease (IHD) and ischemic stroke comprise arterial thromboembolism (ATE), while deep venous thrombosis (DVT) and Pulmonary embolism (PE) comprise venous thromboembolism (VTE). The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis has listed ischemic heart disease as the top cause of mortality for the last 2 decades. Methods: In our study, we utilized the CDC WONDER database to analyze trends in death rates due to ATE among the US population aged 45 and older. We performed statistical analysis to calculate age-adjusted mortality rates (AAMRs) per million, the average annual percent change (AAPC) and corresponding 95% confidence intervals (CI). Results: ATE accounted for 58914 deaths in the US from 1999 to 2020, with an overall decline in AAMR from 3.51 to 2.69 per million. Two joinpoints were noted: a drop from 1999-2009 (APC: –6.01), a slight rise from 2009-2015 (APC 0.76), and a significant rise from 2015-2020 (APC 6.37). Overall, AAPC was –1.25 (95% CI –2.03 to –0.47, p = 0.001). Crude death rates due to ATE increased progressively with age. Among individuals aged 45–54 years, the rate was 0.47 per million, rising to 1.08 in the 55–64 age group. It further increased to 2.4 in those aged 65–74, 5.43 in the 75–84 age group, and reached 14.9 per million in individuals aged 85 and older. AAMR in females was slightly higher (2.26) compared to males (2.19). However, the decline in mortality over time was more pronounced among females (AAPC: –1.53; 95% CI –2.41 to –0.65) as compared to males (AAPC: –0.82; 95% CI –1.74 to 0.10). The White population showed a significant decline (AAPC –1.26), while changes in Asian/Pacific Islanders (–1.09), Hispanics (–0.58) were not significant. Blacks had a slight non-significant increase (AAPC 0.065). Rural areas exhibited higher AAMR than urban areas (2.75 vs. 2.14). Metropolitan areas had a significant decline (AAPC –1.35), non-metropolitan areas showed a smaller and non-significant decline (AAPC –0.75). California reported the highest number of deaths (6,110), while Alaska had the lowest (92). Conclusion: Arterial thromboembolism mortality declined overall from 1999 to 2020, but recent increases and persistent disparities across gender, race and region highlight the need for targeted public health strategies.