Chronic Kidney Disease and Ischemic Heart Disease Mortality in the United States: A 25-Year Review of Racial and Geographic Disparities

Abstract

Chronic kidney disease (CKD) and ischemic heart disease (IHD) are leading causes of death in the United States, with a bidirectional relationship exacerbating morbidity and mortality. Despite advancements in treatment, disparities persist across demographic and geographic groups. This study examines trends in CKD- and IHD-related mortality from 1999 to 2023, assessing variations by age, sex, race/ethnicity, and geographic location. Using the Centers for Disease Control and Prevention Wide-Ranging ONline Data for Epidemiologic Research (CDC WONDER) database data, we analyzed death certificates with IHD as the underlying cause and CKD as a contributing cause among adults aged ≥25 years. Using the Joinpoint regression analysis, we calculated age-adjusted mortality rates (AAMR) per 100,000 patients and average annual percentage changes to analyze the mortality trends. From 1999 to 2023, CKD and IHD were associated with 336,476 deaths. The AAMR significantly declined from 8.09 to 4.28 (annual percent change: -2.50%, P < 0.001). Males had higher AAMRs than females (6.42 vs 2.79 in 2023), though both groups showed a significant decline. In 2023, non-Hispanic (NH) Black individuals had the highest mortality rates (5.88), followed by NH Whites (4.21), Hispanics/Latinos (3.29), and NH other populations (3.01). Geographically, the Western region initially had the highest AAMR, and urban areas had higher mortality rates than rural areas (5.62 vs 4.83 in 2020), though both declined over time. CKD- and IHD-related mortality decreased overall, but disparities persisted across racial/ethnic and geographic subgroups. Targeted interventions are needed to address ongoing inequities and further reduce the dual burden of these interconnected conditions.

Keywords: CDC WONDER; chronic kidney disease; ischemic heart disease; mortality.