Trends in Premature Mortality Due to Alcoholic Cardiomyopathy Among Working Adults Aged 25-64 Years in the United States, 1999-2024: A CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) Analysis.

Background Alcoholic cardiomyopathy (ACM) is an important alcohol-related cardiovascular condition associated with heart failure and premature mortality. However, long-term national trends in ACM mortality among working-age adults and changes during the COVID-19 pandemic remain incompletely characterized. Methods We conducted a retrospective population-based analysis of United States (US) mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Deaths with ACM (International Classification of Diseases, Tenth Revision [ICD-10] code I42.6) as the underlying cause of death were identified for 1999-2024. Adults aged 25-64 years were considered the working-age population. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) were calculated per 1,000,000 population, with analyses stratified by sex, ethnicity (Hispanic origin), and age subgroup. Results Between 1999 and 2024, there were 13,741 deaths attributed to ACM, including 9,705 (70.63%) among adults aged 25-64 years. The pooled premature CMR was 2.3 per 1,000,000 population (95% CI: 2.2-2.3). Men accounted for 85.24% of premature deaths, with a pooled CMR of 3.9 per 1,000,000 compared with 0.7 per 1,000,000 among women. Adults aged 45-64 years accounted for 78.79% of premature deaths and had a CMR of 3.8 per 1,000,000 compared with 0.9 per 1,000,000 among those aged 25-44 years. Mortality increased during 2020-2021, reaching a peak in 2021, followed by a progressive decline through 2024. In 2024, the premature CMR was 1.9 per 1,000,000. AAMRs largely followed CMR trends. Conclusion ACM accounted for a substantial proportion of premature alcohol-related cardiovascular mortality in working-age adults in the US. Mortality was disproportionately concentrated among men and adults aged 45-64 years, increased during 2020-2021, and subsequently declined. These findings highlight persistent disparities and the need for continued prevention, early recognition, and targeted reduction of alcohol-related cardiovascular risk.