Abdul Jabbar Ali Bin, Ismayl Mahmoud, Klisares Mason, Osborne John, Azouz Mohamed, Tak Hyo Jung, Aboeata Ahmed, Kabach Amjad, Goldsweig Andrew M
Department of Medicine, Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Cardiovasc Revasc Med. 2025 Sep 5. doi: 10.1016/j.carrev.2025.08.021.
Acute myocardial infarction (AMI) is a leading cause of cardiovascular disease (CVD) mortality among young and middle-aged individuals in the United States (US). Though AMI mortality overall has been decreasing in the US, contemporary trends in AMI-related mortality in the young and middle-aged population and the impact of the COVID-19 pandemic on these trends are unknown.
The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database was used to analyze death certificates from 1999 to 2023 for AMI-related deaths among the US population aged 25-64. Age-adjusted mortality rates (AAMRs) per 100,000 people and associated annual percent changes (APCs) were calculated using Joinpoint regression analysis. Mortality trends were stratified by sex, race/ethnicity, census region, and state for comparative analysis.
From 1999 to 2023, there were 970,454 AMI-related deaths among U.S. adults aged 25-64 years. The annual number of AMI-related deaths decreased from 44,040 in 1999 to 31,522 in 2023. The overall AAMR per 100,000 decreased from 31.02 deaths (95 % confidence interval [CI] 30.73-31.31) in 1999 to 15.29 (95 % CI 15.11-15.46) in 2023 (average APC -2.92 %, 95 % CI -3.22 to -2.75). The AAMR per 100,000 declined at a faster rate from 31.02 in 1999 to 19.57 in 2010 (1999-2010, APC -4.26), followed by a slower rate from 19.57 in 2010 to 16.67 in 2019 (2010-2019, APC -1.41). The declining trend was disrupted by a transient increase during the COVID-19 pandemic, with a peak AAMR of 19.73 (95 % CI, 19.53 to 19.93) in 2021 (2019-2021, APC 8.52). The declining trend resumed from 2021 to 2023, with AAMR decreasing to its lowest levels of 15.29 in 2023 (2021-2023, APC -12.58). Heterogeneity across demographic and regional groups narrowed during these 25 years. However, disparities are still prevalent, with men, non-Hispanic (NH) Black or African American, American Indian or Alaska Native, and residents of the Southern United States having higher mortality rates.
AMI-related mortality declined significantly from 1999 through 2023 in the young and middle-aged population of the US. AMI-related mortality rates increased transiently during the COVID-19 pandemic, but the declining trend resumed in 2022. Differences across demographic and regional subgroups narrowed; however, disparities remain prevalent and require comprehensive efforts to improve cardiovascular health, outcomes, and health equity among the young and middle-aged populations of the US.
