National trends and disparities in coronary artery disease and depression-related mortality in the United States, 1999-2025: A population-based CDC WONDER analysis.

BACKGROUND

Coronary artery disease (CAD) and depressive disorders frequently coexist, but national mortality patterns involving both conditions remain incompletely characterized.

OBJECTIVE

To evaluate temporal trends and demographic and geographic disparities in mortality involving CAD and depressive or depressive-anxiety disorders in the United States from 1999 to 2025.

METHODS

We analyzed U.S. residents aged ≥25 years using the CDC WONDER Multiple Cause of Death database. Deaths were included when CAD (ICD-10 I20-I25) and a depressive or depressive-anxiety disorder (F32, F33, or F41.2) were both recorded on the same death certificate, irrespective of underlying or contributing cause. Age-adjusted mortality rates (AAMRs) were standardized to the 2000 U.S. population, and temporal trends were assessed using Joinpoint regression. Data were extracted April 10, 2026; 2025 mortality data were provisional. Urbanization analyses were limited to 1999-2020.

RESULTS

Among 85,806 deaths, the mean annual AAMR was 1.42 per 100,000 population. AAMR declined from 1.81 (95% CI, 1.75-1.87) in 1999 to 1.31 (95% CI, 1.26-1.35) in 2025 (AAPC, -1.38%; 95% CI, -2.24 to -0.50; p = 0.002), despite an increase during 2017-2020. Mean annual AAMRs were higher among males than females (1.52 vs 1.33), White individuals (1.59), the Midwest (1.91), and nonmetropolitan versus metropolitan areas during 1999-2020 (1.94 vs 1.33). Mortality increased among adults aged 35-44 and 55-64 years and among Black individuals from 2014 to 2025.

CONCLUSIONS

Mortality involving both conditions declined overall but varied substantially across demographic and geographic subgroups, with increases in some younger and middle-aged populations.