Aortic dissection mortality in the United States, 1968-2023: Trends, disparities, and deep learning forecasts.

BACKGROUND

The population-level burden and inequities of aortic dissection (AD) mortality in the United States remain incompletely defined, and contemporary, data-driven forecasts are scarce.

METHODS

Using the CDC WONDER Death database (1968-2023), AD deaths were identified by ICD codes (ICD-8/9: 441.0; ICD-10: I71.0). Age-adjusted mortality rates (AAMRs) per 100,000 were stratified by sex, race, age, and Census region. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average APC (AAPC). Forecasts through 2033 employed a Bi-GRU model.

RESULTS

We analyzed 175,930 AD-related deaths. Overall, the national AAMR declined by 43 % across 1968-2023 (AAPC -1.10 %, 95 % CI -1.19 to -1.00) but showed a recent upturn (APC +2.00 %, 95 % CI 1.53-2.57). Mortality remained higher in men than women and in Black than White individuals, increased steeply with age, and varied geographically. Bi-GRU forecasts project a modest national decline in AAMR from 1.62 to 1.47 by 2033, with persistent sex (men 1.91 vs women 1.12) and racial (Black 2.32 vs White 1.35) gaps; a slight increase is confined to the South (1.62 → 1.64), while rates in adults ≥85 years improve (10.26 → 9.70).

CONCLUSIONS

While U.S. AD mortality has nearly halved over five decades, recent increases and persistent demographic and regional disparities highlight uneven progress. Forecasts to 2033 suggest modest overall declines with persistent sex and racial gaps; targeted hypertension control and regional access to high-volume aortic centers remain priorities.