Spatiotemporal Mortality Patterns and Temperature-Associated Risk of Aortic Dissection in the United States: A National CDC WONDER Database Analysis.

PURPOSE: Aortic dissection (AD) is a life-threatening aortic emergency that progresses rapidly and carries a high mortality rate. We characterised contemporary patterns and long-term trends in AD mortality in the United States and examined associations between ambient temperature and AD mortality.

PATIENTS AND METHODS: We obtained mortality data for AD from United States CDC WONDER for 1999-2023 and calculated age-adjusted mortality rates (AAMR). Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Monthly air temperature data for the period 1999-2023 were obtained from the North America Land Data Assimilation System (NLDAS). Associations between temperature and AD mortality were evaluated across census regions using correlation analyses and Poisson regression models. To explore the future burden, subgroup-specific time series models (ARIMA or ETS) were applied to generate 20-year forecasts.

RESULTS: In 2023, there were 4,418 AD deaths (AAMR 1.73 per 100,000; 95% CI 1.68-1.78); rates were highest in the Midwest (1.96), in male (2.19 vs 1.24 in female), in non-Hispanic Black individuals (2.75), and in adults ≥85 years (11.67). From 1999-2023, 86,943 deaths occurred and the overall AAMR declined (AAPC -0.37), but reversed to sustained increases after 2013. Across the four census regions, the monthly AAMR was lowest in summer and highest in winter during 1999-2023 (P < 0.05). A 10°F increase in temperature was associated with lower mortality risk (eg, South RR 0.889).

CONCLUSION: AD mortality has rebounded since 2013 with marked demographic and regional disparities. Lower temperatures and greater thermal variability are linked to higher mortality, supporting seasonally and region-tailored prevention and health-system preparedness.