Trends and Disparities in Valvular Heart Disease Mortality in the United States From 1999 to 2020

Abstract

Background: Percutaneous heart valve procedures have been increasingly performed over the past decade, yet real-world mortality data on valvular heart disease (VHD) in the United States remain limited.

Methods and results: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database among patients ≥15 years old from 1999 to 2020. VHD and its subtypes were listed as the underlying cause of death. We calculated age-adjusted mortality rate (AAMR) per 100 000 individuals and determined overall trends by estimating the average annual percent change using the Joinpoint regression program. Subgroup analyses were performed based on demographic and geographic factors. In the 22-year study, there were 446 096 VHD deaths, accounting for 0.80% of all-cause mortality (56 014 102 people) and 2.38% of the total cardiovascular mortality (18 759 451 people). Aortic stenosis recorded the highest mortality of VHD-related death in both male (109 529, 61.74%) and female (166 930, 62.13%) populations. The AAMR of VHD has declined from 8.4 (95% CI, 8.2-8.5) to 6.6 (95% CI, 6.5-6.7) per 100 000 population. Similar decreasing AAMR trends were also seen for the VHD subtypes. Men recorded higher AAMR for aortic stenosis and aortic regurgitation, whereas women had higher AAMR for mitral stenosis and mitral regurgitation. Mitral regurgitation had the highest change in average annual percent change in AAMR.

Conclusions: The mortality rate of VHD among the US population has declined over the past 2 decades. This highlights the likely efficacy of increasing surveillance and advancement in the management of VHD, resulting in improved outcomes.

Keywords: aortic valvular disease; mitral valvular disease; mortality; trend and disparity; valvular heart disease.

Figure 1. State‐level age‐adjusted mortality rate for VHD and trends in AAMR for VHD subtypes, stratified by sex, between 1999 and 2020.

AAMR indicates age‐adjusted mortality rate; AR, aortic regurgitation; AS, aortic stenosis; MR, mitral regurgitation; MS, mitral stenosis; TAVR, transcatheter aortic valve replacement; TMVR, transcatheter mitral valve replacement; and VHD, valvular heart diseases.

Figure 2. Trends in age‐adjusted mortality rate for VHDs, stratified by sex, between 1999 and 2020.

VHD indicates valvular heart disease.

Figure 3. Percent of mortality due to cardiovascular disease and valvular heart disease with its subtypes in different age groups.