Trends and disparities of cardiovascular mortality among adults with depression in the United States from 1999 to 2023.

BACKGROUND

Depression is increasingly recognized as a significant cardiovascular risk factor, yet comprehensive long-term trends in cardiovascular mortality among adults with depression remain poorly characterized.

METHODS

We analyzed cardiovascular deaths among US adults aged ≥25 years with depression from 1999 to 2023 using national mortality data. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated. Joinpoint regression analysis determined annual percent changes (APC).

RESULTS

Between 1999 and 2023, 92,339 cardiovascular deaths were recorded among US adults with depression. Overall AAMR decreased significantly from 2.42 per 100,000 (95 % CI: 2.35-2.49) in 1999 to 1.52 per 100,000 (95 % CI: 1.47-1.56) in 2023, representing an AAPC of -1.96 %. Two critical phases emerged: significant decline during 2002-2010 (APC: -6.89 %) followed by concerning reversals from 2018 to 2021 (APC: +6.83 %). Women consistently maintained higher AAMR than men throughout the study period. Alarming trends appeared among younger adults, with 35-64 years groups showing increasing mortality rates. NH White adults demonstrated the highest cardiovascular mortality rates persistently, while NH Black adults showed minimal improvement (AAPC: +0.14 %). Regional disparities gradually diminished, though the Midwest consistently exhibited the highest rates. The cardiovascular disease spectrum transformed significantly: essential hypertension emerged as the second leading cause (77.8 % increase in deaths), while atherosclerotic heart disease maintained its position as the leading cause.

CONCLUSIONS

Despite overall declining cardiovascular mortality among patients, concerning reversals in younger adults, persistent sex and racial disparities, and evolving disease patterns necessitate targeted interventions to address healthcare inequities in this vulnerable population.