Abstract / Summary
Abstract Background Coronary artery disease (CAD) is one of the major causes of death in the United States, whereas substance related conditions (SRC) are increasingly on the rise in the country. There is a paucity of information on national trends of CAD mortality over time with coexisting substance related conditions (SRC). Methods We presented a retrospective population-based study, based on CDC WONDER multiple-cause-of-death data of 1999–2020. They included adults who had CAD (ICD-10 I20-I25) and SRC mentioned anywhere on the death certificates. Mortality rates; Crude Mortality Rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and adjusted to the U.S. population. Annual percent changes (APCs) and average annual percent changes (AAPCs) were estimated by using joinpoint regression. Results 813,333 deaths in the United States between 1999 and 2020 involved co-occurring CAD (as the underlying cause) and a SRC (as a contributing cause). The overall AAMR rose significantly from 4.20 in 1999 to 22.80 in 2020 (AAPC: 8.28). Mortality among males was greater than that among females (2020 AAMR: 36.50 and 11.50, respectively), but both groups had significant increases. American Indians had the highest overall AAMR (17.19) as compared to the lowest in Asians (3.57). The highest burden of mortality was in adults aged 65 years (2020 AAMR: 74.74). In 2020, mortality rate was higher in non-urban regions than in urban regions (34.00 vs. 20.66). The highest AAMR was in the Midwest (19.96) regionally. There was significant discrepancy at the state level with Montana and Vermont recording the highest rates and Mississippi recording the lowest. Conclusion Mortality among individuals with co-occurring CAD and SRC rose significantly in the past 20 years, being disproportionately higher in males, older adults, in rural areas, and some racial groups. The combination of cardiovascular and SRC preventive measures is urgently required to mitigate this increasing community health burden.