Alcoholic cardiomyopathy–related mortality in the United States, 1999–2024: temporal trends and sociodemographic and geographic disparities

Background Alcoholic cardiomyopathy is associated with long-term heavy alcohol consumption and may progress to heart failure and death. This study evaluated temporal trends in alcoholic cardiomyopathy mortality among US adults aged ≥25 years from 1999 to 2024. Methods Mortality data for US residents aged ≥25 years were obtained from the Centers for Disease Control and Prevention (CDC) WONDER database. Deaths with alcoholic cardiomyopathy (ICD-10 code I42.6) recorded as the underlying cause were identified. Death counts, age-adjusted mortality rates (AAMRs), crude death rates (CDRs), and 95% confidence intervals (CIs) were calculated. Joinpoint regression was used to estimate annual percentage changes (APCs) and average annual percentage changes (AAPCs), with analyses stratified by age group, sex, race/ethnicity, census region, and urbanization. Results Overall, 13,710 deaths associated with alcoholic cardiomyopathy were recorded during 1999–2024. The AAMR declined from 0.31 (95% CI: 0.28–0.33) in 1999 to 0.22 (95% CI: 0.21–0.24) in 2024 (AAPC = −1.01%, 95% CI: −1.78 to −0.30). The decline was significant from 1999 to 2003 (APC = −8.80%, 95% CI: −19.36 to −2.88), followed by no significant change from 2003 to 2024 (APC = 0.54%, 95% CI: −0.01 to 1.43). Mortality was significantly higher in men than in women, and the male AAMR was significantly higher than the female AAMR. The male AAMR decreased from 0.63 to 0.32 (AAPC = −2.40%, 95% CI: −2.99 to −1.84), whereas the female AAMR changed from 0.07 to 0.08 (AAPC = 0.88%, 95% CI: −0.82 to 2.46). Among racial/ethnic groups, non-Hispanic Black individuals had the highest AAMR in 1999 (0.76), which decreased to 0.22 in 2024. The AAMR among non-Hispanic White individuals changed from 0.26 to 0.23 (AAPC = 0.98%, 95% CI: 0.17–1.84), while that among Hispanic individuals decreased from 0.33 to 0.10. The 55–64-year age group had the largest number of deaths and the highest CDR in 2024 (0.37). The West recorded the most deaths and the highest regional AAMR in 2024. In large metropolitan areas, the AAMR decreased from 0.34 in 1999 to 0.20 in 2020 (AAPC = −2.23%, 95% CI: −3.45 to −0.59). Conclusion Alcoholic cardiomyopathy mortality decreased overall among US adults aged ≥25 years between 1999 and 2024, but significant sociodemographic and geographic differences remained. These findings support continued efforts to identify high-risk alcohol use, address alcohol use disorder, and detect cardiomyopathy early.