Trends and disparities in coronary artery disease related mortality among adults with chronic kidney disease in the United States from 1999 to 2019.

BACKGROUND AND AIM: Coronary artery disease (CAD) and chronic kidney disease (CKD) often coexist and contribute significantly to cardiovascular mortality. This study aims to evaluate national trends and disparities in CAD-related mortality among U.S. adults with CKD from 1999 to 2019.

METHODS AND

RESULTS

Mortality data from the CDC WONDER database were analyzed, identifying CAD (ICD-10 codes I20-I25) and CKD (ICD-10 code N18) as multiple causes of death. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 persons were calculated. Annual percentage change (APC) and average annual percentage change (AAPC) were used to assess trends over time using Joinpoint regression. A total of 523,131 deaths were recorded between 1999 and 2019. The AAMR declined from 13.12 in 1999 to 9.62 in 2019, with an AAPC of -1.58% (95 % CI: -3.22 to 0.09; p = 0.06). Men had a higher AAMR (16.91) compared to women (8.15). Non-Hispanic (NH) Black individuals had the highest AAMR (18.87), followed by NH American Indians (12.89), Hispanics (12.25), NH White (10.84) and NH Asians (10.04). Nonmetropolitan areas reported a higher AAMR (12.21) compared to metropolitan areas (11.52). Regionally, the Midwest recorded the highest AAMR (12.36). States in the top 90th percentile reported double the AAMRs compared to those in the bottom 10th percentile.

CONCLUSIONS

While CAD-related mortality among CKD patients has declined over the past two decades, the burden remains disproportionately high among men, NH Black individuals, and residents of rural areas and the Midwest. Targeted and equity-focused interventions are essential to reduce these disparities.