Nationwide trends and disparities in deaths following cardiogenic shock and sepsis in the United States (1999-2023): insights from the CDC WONDER database.

BACKGROUND

Cardiogenic shock (CS) with sepsis is a highly fatal condition, yet national mortality trends and demographic disparities in these co-occurring conditions remain poorly characterized.

METHODS

We analyzed CDC WONDER Multiple Cause of Death data (1999-2023) to identify adult deaths involving both CS and sepsis. Age-adjusted mortality rates (AAMRs), crude mortality rates (CMRs), average annual percent change (AAPC), and annual percent change (APC) by period were calculated and stratified by sex, race, age, census region, urbanization, and state.

RESULTS

From 1999 to 2023, 59,898 deaths were recorded, overwhelmingly in inpatient medical facilities (94.61%). The national AAMR rose from 0.65 (1999) to 2.01 (2023), with an overall AAPC of 5.39 (95% CI: 4.24-6.56, p < 0.001). Mortality was higher in males (AAMR: 1.28; AAPC: 5.20) compared to females (AAMR: 0.78; AAPC: 5.35). NH Black or African American individuals had the highest AAMR (1.69), followed by Hispanic (0.98), and NH White (0.93). Older adults had the greatest CMR (3.51), compared with middle-aged (0.77) and young adults (0.12). By region, AAMR was highest in the South (1.06) and Northeast (1.05), lower in the Midwest (0.84), and lowest in the West (0.10). Non-metropolitan areas had higher AAMR (0.89; AAPC: 6.34) compared with metropolitan areas (0.86; AAPC: 4.78). States with the highest burden included Rhode Island, North Carolina, West Virginia, and Connecticut.

CONCLUSION

Mortality from CS with sepsis increased significantly over two decades, with pronounced disparities across sex, race, age, and geography. These findings highlight the urgent need for targeted national strategies.