Mortality Trends from Acute MI with Underlying CKD in the US from 1999 to 2020: A Cross-Sectional Analysis of the CDC WONDER Database.

purposeChronic kidney disease increases the risk of acute myocardial infarction and worsens outcomes. Despite advances in care, mortality rate disparities regarding gender, race and socioeconomic status persist. This study examines trends in acute myocardial infarction-related mortality among chronic kidney disease patients in the United States from 1999 to 2020.

methodsWe analyzed mortality data from the CDC WONDER database, identifying deaths with acute myocardial infarction (International Classification of Diseases, 10th Revision [ICD-10] codes I21-I22) as the underlying cause and chronic kidney disease (ICD-10 N18) as a contributing cause. Age-adjusted mortality rates per 100,000, standardized to the 2000 US population, were calculated and stratified by sex, race/ethnicity, urbanization, and state. Trends were assessed using Joinpoint regression to estimate annual percentage change with 95% confidence intervals.

resultsA total of 72,780 acute myocardial infarction-related deaths in chronic kidney disease patients aged 25-85 years occurred from 1999 to 2020. The age adjusted mortality rate declined from 2.46 in 1999 to 0.99 in 2020 (annual percent change: -4.09; 95% CI -5.54 to -2.60). Men had higher mortality than women (age adjusted mortality rate: 2.11 vs. 1.13). Non-Hispanic Black individuals had the highest age adjusted mortality rate (2.90). Nonmetropolitan areas showed higher rates than metropolitan areas (1.63 vs. 1.51). A significant increase in mortality was observed among Hispanic patients from 2015 to 2020 (annual percent change: 8.15; 95% CI 1.13-15.65).

conclusionsAcute myocardial infarction-related mortality in chronic kidney disease patients has declined overall, but persistent disparities by sex, race/ethnicity, and geography highlight the need for continued efforts and targeted interventions in this high-risk population.