Disparities in gastrointestinal bleeding and acute myocardial infarction-related mortality in the United States, 1999-2020.

Gastrointestinal bleeding (GIB) and acute myocardial infarction (AMI) are major emergencies with rising evidence of a bidirectional relationship. Post-AMI antithrombotics increase GIB risk, while GIB may worsen cardiac outcomes. While short-term effects are recognized, long-term mortality trends for co-occurring GIB and AMI remain understudied. We examined temporal and demographic mortality patterns in the U.S. from 1999 to 2020. We used CDC WONDER mortality data for adults aged ≥25 years. Deaths listing both GIB and AMI as underlying or contributing causes were included. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated, and Joinpoint regression was used to estimate annual percent change (APC) and average APC (AAPC), stratified by sex, age, race/ethnicity, and urban-rural status. A total of 51,113 deaths were attributed to GIB and AMI. AAMR declined from 1.72 in 1999 to 0.81 in 2020 (AAPC -3.9%), with the steepest decline from 2002 to 2010 (APC -7.5%). Males had higher mortality than females (1.43 vs. 0.81). Non-Hispanic Black individuals had the highest AAMR (1.26) but also a steep decline (AAPC -4.43%). AAMRs were higher in rural (1.01) than urban areas (0.94). The 85+ age group had the highest mortality but greatest decline (AAPC -4.15%). The Northeast had the highest regional AAMR (1.15). From 1999 to 2020, U.S. mortality from GIB and AMI declined significantly, likely due to improved cardiovascular and bleeding risk management. However, persistent disparities by sex, race, age, and geography remain, underscoring the need for more targeted and equitable strategies.