Trends in Cardiovascular Disease Mortality among U.S. Children, 1999–2020

Abstract

Objectives: Cardiovascular diseases (CVD) account for 40% of deaths in children in the U.S., making CVD deaths prominent. Detection of CVD is vital across all age groups. Knowledge gaps regarding CVD risk factor prevention should be addressed through health policies and educational public health programs among at-risk populations. Methodology: We analyzed CVD-related mortality trends in the U.S. using the CDC WONDER database, including death certificates from all 50 states and the District of Columbia. CVD-related deaths were identified using ICD codes I00-I99. Pediatric cases were defined as individuals aged 14 or younger. Mortality data from January 1999 to December 2022 were extracted, with demographic variables including sex/gender, race/ethnicity, urbanization status, and census regions. Age-adjusted mortality rates (AAMR) per 100,000 people were calculated by standardizing the 2000 U.S. population. Join Point Regression calculated the Annual Percentage Change (APC) and identified significant trends. The study followed STROBE guidelines and was exempt from IRB approval due to de-identified data use. Results: Overall, mortality declined from 8.38 in 1999 to 6.06 in 2015, before increasing to 6.73 by 2022. Males consistently had higher rates than females. Racial disparities were observed, with the highest mortality in NH Black or African American children. Mortality decreased in most regions, with a significant rise in the South after 2020. Metropolitan areas saw steady declines, while non-metropolitan areas had higher rates. Conclusion: Pediatric CVD mortality in the U.S. has generally declined since 1999, but recent increases, particularly among males, racial minorities, and the South, highlight ongoing disparities. Targeted interventions are needed to reduce CVD mortality in vulnerable groups.