Ischemic heart disease-related mortality trends in the United States (1999-2020) and prediction using machine learning

Abstract

Background: Ischemic heart disease (IHD) remains the leading cause of mortality globally, contributing significantly to rising healthcare costs. This study aims to analyze trends in IHD-related mortality from 1999 to 2020 using data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database.

Methods: Mortality data from 1999 to 2020 were extracted from the CDC WONDER database, with IHD identified as the primary cause of death (International Classification of Diseases, 10th Revision Codes: I20-I25). Age-adjusted mortality rates (AAMRs) were calculated and analyzed. Trends were assessed using Joinpoint Regression Analysis to determine the annual percentage change (APC). Additionally, predictive modeling was performed using an autoregressive integrated moving average model implemented in Python and Generative Pre-trained Transformer 4.

Results: The study observed a decline in AAMR over the 22-year period, totaling 9 105 056 deaths. The APC revealed a significant decline in mortality rates until 2011 [APC: -4.99, P < 0.05, 95% confidence interval (CI): -5.3 to -4.7], followed by a slower decline through 2020 (APC: -2.35, P < 0.05, 95% CI: -2.8 to -1.6). Both males (AAMR: 161.4, 95% CI: 161.3-161.6) and females (AAMR: 93.1, 95% CI: 93.0-93.2) experienced a continuous decline in APC until 2018, after which trends began to reverse. African Americans had the highest AAMR (144.1, 95% CI: 143.8-144.3), followed by Whites (125.3, 95% CI: 125.3-125.4), American Indians (106.1, 95% CI: 105.0-107.2), Hispanics (92.9, 95% CI: 92.7-93.2), and Asians (67.1, 95% CI: 66.8-67.4). Geographically, the Mid-Atlantic region exhibited the highest AAMR, followed by the East South-Central region. Among states, Oklahoma had the highest AAMR, followed by New York. Non-metropolitan areas had the highest mortality rates, whereas large-fringe metropolitan areas exhibited the lowest. Predictive analysis suggests a potential plateau or slight increase in mortality rates by 2035 (AAMR: 104.5, 95% CI: 50.05-159.64).

Conclusions: The observed slowing in the decline of IHD mortality rates and the potential for future increases underscore the need for sustained public health interventions and vigilant surveillance to mitigate the burden of IHD.

Keywords: cardiovascular diseases; epidemiology; ischemic heart disease; mortality trends, public health.

Figure 1.

Annual percentage change (APC) of ischemic heart disease (IHD) mortality rates year wise and among different genders in the United States, 1999–2020.

Figure 2.

Annual percentage change (APC) of ischemic heart disease (IHD) mortality rates by race in the United States, 1999–2020.

Figure 3.

Ischemic heart disease mortality trends (age-adjusted mortality rate) among states of the United States, 1999–2020. Source: CDC WONDER.

Figure 4.

Forecast of ischemic heart disease mortality trends in the United States till 2035.