Premature Coronary Artery Disease Related Mortality in the United States: Regional, Gender, and Racial Disparities - Insights from the CDC WONDER Database (1999-2023)

BackgroundPremature coronary artery disease (PCAD) continues to impose a disproportionate burden on younger adults in the United States, yet recent patterns across sex, region, race, and urbanization remain poorly defined. MethodsUsing CDC WONDER data from 1999-2023, we examined PCAD-related age-adjusted mortality rates (AAMR) for males <45 years and females <55 years, stratified by region, race/ethnicity, and urbanization. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). ResultsThe combined AAMR for PCAD in the U.S. is approximately 8.5 deaths per 100,000 population. Both sexes demonstrated overall declines in PCAD mortality since 1999 (AAPC males -0.84%; females -1.07%), interrupted by a transient rise during 2018-2021 (APC = 7.85%; 95% CI 5.41-9.32), followed by a sharp post-pandemic decline (APC = -7.39%; 95% CI -10.64 to -4.53). Females consistently exhibited higher mean AAMRs than males (8.74 vs. 8.34; p<0.00001). Regional analyses showed that mortality rates were highest in the South (males 9.86; females 10.96) and Midwest (8.97; 9.36), with intermediate rates in the Northeast (males 7.09, females 6.77), and the lowest rates in the West (6.35; 6.16). Non-metropolitan residents carried a 1.5-1.7-fold greater mortality burden than metropolitan populations (males 12.20 vs. 7.74; females 13.31 vs. 8.06). Black/African Americans had the highest rates (males: 12.17, females: 15.98), followed by American Indian/Alaska Natives (8.49, 9.02) and Whites (8.0, 8.0), while Asian/Pacific Islanders had the lowest (about 2.4-4.3). ConclusionsNational PCAD mortality has decreased, but disparities persist and are growing by region, race, sex, and urbanization. Concentration in the Southern and Midwestern states and among certain races highlights the need for further research using modern molecular methods and improved health care resources. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=200 SRC="FIGDIR/small/25342435v1_ufig1.gif" ALT="Figure 1"> View larger version (45K): org.highwire.dtl.DTLVardef@5fa12dorg.highwire.dtl.DTLVardef@4eb887org.highwire.dtl.DTLVardef@34b48forg.highwire.dtl.DTLVardef@3a2be1_HPS_FORMAT_FIGEXP M_FIG C_FIG Clinical PerspectiveO_ST_ABSWhat is New?C_ST_ABSO_LIThe combined AAMR for PCAD in the U.S. is approximately 8.5 deaths per 100,000 population. C_LIO_LIPremature coronary artery disease-related mortality rates are higher in the Southern and Midwestern states, among non-Hispanic Black, Native American, and non-metro populations. C_LI What are the Clinical Implications?O_LIThe geographic and demographic clustering of cases strongly suggest contributions from underlying genetic, environmental, and dietary factors that warrant further investigation. C_LIO_LIEarly identification of at-risk individuals through precision-medicine approaches and the implementation of targeted, evidence-based preventive strategies could mitigate these regional and racial disparities. C_LI