Alcoholic Cardiomyopathy Mortality in the United States (1999-2024): Trends, Disparities, and Opportunities for Prevention

Aim: This study aimed to characterize long-term US mortality from alcoholic cardiomyopathy (ACM), compare its trajectory with other major cardiomyopathy subtypes, and identify demographic and geographic disparities relevant to cardiovascular prevention.Methods: We conducted a serial cross-sectional analysis of Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) underlying-cause-of-death data from 1999 to 2024.Cardiomyopathy deaths were identified using ICD-10 codes I42.0, I42.1, I42.2, I42.5, I42.6, I42.8, and I42.9.Annual age-adjusted mortality rates (AAMRs) were assessed overall and by sex; agespecific crude death rates (CDRs) were recalculated for ages 15-44, 45-64, and 65-84 years.ACM mortality was also examined by race and state.Results: From 1999 to 2024, AAMRs declined for dilated cardiomyopathy (1.965 to 0.716 per 100,000; -63.6%), unspecified cardiomyopathy (7.196 to 3.155; -56.2%), and other hypertrophic cardiomyopathy (0.450 to 0.228; -49.2%).ACM declined less, from 0.199 to 0.144 (-27.7%), with an increase during the early 2020s.Male ACM AAMR declined from 0.408 to 0.209 but remained nearly fourfold the female rate in 2024 (0.054).Mortality was concentrated among middle-aged and older males; American Indian or Alaska Native individuals had the highest population-based ACM mortality, and Alaska had the highest pooled state AAMR in 2018-2024.Conclusion: ACM showed a smaller long-term mortality reduction than several major cardiomyopathy subtypes and persistent demographic and geographic disparities.Integrating cardiovascular prevention and heart failure care with recognition and treatment of harmful alcohol use may help reduce this potentially modifiable burden.