Faheem Muhammad Shaheer Bin, Fatima Yumna, Munir Syeda Umbreen, Khabir Momina, Khatri Nisha
Karachi Institute of Medical Sciences, KIMS, Karachi, Sindh, Pakistan.
Shaheed Mohtarma Benazir Bhutto Medical College, Lyari, Pakistan.
Thromb Res. 2025 Sep 18;255:109482. doi: 10.1016/j.thromres.2025.109482.
Ischemic heart disease (IHD) and thromboembolism continue to contribute to significant cardiovascular mortality in the United States in spite of increased prevention and treatment. Underlying both arterial and venous events, such as stroke, pulmonary embolism (PE), and deep vein thrombosis (DVT), is thrombosis. With the aging of the population and increased risk factors such as obesity and diabetes, awareness of long-term trends in mortality is needed. In this article, CDC WONDER data are used to assess national trends in IHD- and thromboembolism-associated mortality from 1999 to 2024, with attention given to variation by age, sex, and race/ethnicity to inform future public health programs.
Mortality data for IHD-thromboembolism among those aged ≥45 in the US were extracted from the CDC WONDER (1999-2024), using ICD codes I20-I25 (IHD) and I74, I26, I80-I82 (thromboembolism). Age-adjusted mortality rates were calculated per 100,000 and stratified by age, sex, race/ethnicity, geographic region, and urban-rural classification. Joinpoint regression was used to evaluate average annual percentage change (AAPC) and annual percentage change (APC) with 95 % Confidence Intervals (CIs). A p-value of <0.05 was considered significant.
From 1999 to 2024, 70,339 deaths occurred due to IHD and thromboembolism. The AAMR decreased from 2.6 in 1999 to 2.3 in 2024 with an AAPC of -1.16 (95 % CI: -0.58 to -1.82). The AAMR initially inclined to 2.7 in 2001 with an APC of 1.95 (95 % CI: 5.40 to -1.94) followed by a drastic decline to 1.8 till 2018 with an APC of -2.40 (95 % CI: -2.18 to 4.90), afterward, the AAMR again incline to 2.3 in 2021 with an APC of 7.62 (95 % CI: -10.01 to -2.03). The stratified analysis revealed the highest AAMRs across the age group 85 years and older (16.03). Men consistently had higher AAMR than Women (AAMR: 2.7 vs. 1.9). By race, the highest AAMR was noted among NH Black or African American (3.4), followed by NH white (2.2). Regionally, the South showed the highest AAMR (2.4). Non-Metropolitan exhibited the highest AAMR than Metropolitan (AAMR: 12.6 vs. 10.8).
Despite an overall stable age-adjusted mortality trend of ischemic heart disease and thromboembolism between 1999 and 2024, the most recent years have witnessed a disturbing rise. The most notable disparities persist by age, sex, race, and geographic area, with the largest burden in older adults, men, racial minorities, non-metropolitan residents, and residents of the Midwestern U.S. These findings emphasize the need for targeted interventions and equitable public health interventions to reduce mortality among high-risk groups.
尽管预防和治疗有所增加，但在美国，缺血性心脏病（IHD）和血栓栓塞仍然是心血管疾病死亡的重要原因。无论是动脉还是静脉事件，如中风、肺栓塞（PE）和深静脉血栓形成（DVT），其根本原因都是血栓形成。随着人口老龄化以及肥胖和糖尿病等风险因素的增加，有必要了解死亡率的长期趋势。在本文中，疾病预防控制中心（CDC）的WONDER数据被用于评估1999年至2024年期间IHD和血栓栓塞相关死亡率的全国趋势，并关注年龄、性别和种族/族裔的差异，以为未来的公共卫生项目提供参考。
从CDC的WONDER数据库（1999 - 2024年）中提取美国45岁及以上人群的IHD - 血栓栓塞死亡率数据，使用国际疾病分类（ICD）编码I20 - I25（IHD）和I74、I26、I80 - I82（血栓栓塞）。计算每10万人的年龄调整死亡率，并按年龄、性别、种族/族裔、地理区域和城乡分类进行分层。采用连接点回归评估平均年度百分比变化（AAPC）和年度百分比变化（APC），并给出95%置信区间（CI）。p值<0.05被认为具有统计学意义。
1999年至2024年期间，共有70339例死亡归因于IHD和血栓栓塞。年龄调整死亡率从1999年的2.6降至2024年的2.3，平均年度百分比变化为 - 1.16（95% CI： - 0.58至 - 1.82）。年龄调整死亡率最初在2001年上升至2.7，年度百分比变化为1.95（95% CI：5.40至 - 1.94），随后急剧下降至2018年的1.8，年度百分比变化为 - 2.40（95% CI： - 2.18至4.90），之后，年龄调整死亡率在2021年再次上升至2.3，年度百分比变化为7.62（95% CI： - 10.01至 - 2.03）。分层分析显示，85岁及以上年龄组的年龄调整死亡率最高（16.03）。男性的年龄调整死亡率一直高于女性（年龄调整死亡率：2.7对1.9）。按种族划分，非西班牙裔黑人或非裔美国人的年龄调整死亡率最高（3.4），其次是非西班牙裔白人（2.2）。在区域方面，南部地区的年龄调整死亡率最高（2.4）。非大都市地区的年龄调整死亡率高于大都市地区（年龄调整死亡率：12.6对10.8）。
尽管1999年至2024年期间缺血性心脏病和血栓栓塞的年龄调整死亡率总体呈稳定趋势，但最近几年出现了令人不安的上升。在年龄、性别、种族和地理区域方面存在最显著的差异，老年人、男性、少数族裔、非大都市居民和美国中西部居民的负担最重。这些发现强调需要有针对性的干预措施和公平的公共卫生干预措施，以降低高危人群的死亡率。
