Two-Decade Trends and COVID-Era Acceleration in IHD Mortality Among Adults with Alcohol Use Disorder in the United States, 1999-2024

Background: Alcohol use disorder (AUD) is an underrecognized cardiovascular risk factor linked to accelerated atherosclerosis, arrhythmias, and ischemic heart disease (IHD). National trends in IHD mortality among adults with AUD, particularly during the COVID-19 pandemic, remain poorly characterized. We assessed temporal trends and demographic and geographic disparities in IHD-AUD mortality in the United States from 1999 to 2024. Methods: Mortality data for US adults aged [≥]25 years were obtained from the CDC WONDER Multiple Cause-of-Death database (1999-2024). Deaths listing both IHD (ICD-10 I20-I25) and AUD (F10) were included. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, and Joinpoint regression was used to estimate annual percent changes (APCs) with 95% confidence intervals (CIs). Results: Between 1999 and 2024, 150,273 deaths involved both IHD and AUD. The AAMR declined slightly from 2.0 to 1.9 per 100,000 between 1999 and 2011, increased to 2.7 by 2018, and rose sharply to 3.7 during 2018-2021 (APC, +12.52% [95% CI, 4.97-20.61]; P=0.003), before stabilizing at 3.6 through 2024. Overall mortality increased by approximately 80% from baseline. Mortality increased persistently among adults aged 35-44 years after 2014 (APC, +8.33%) while adults aged 55-64 had the highest mortality rate. Rates were higher in men than women (peak 6.6 vs 1.2 per 100,000). American Indian or Alaska Native individuals had the highest mortality (peak 7.4), whereas Asian or Pacific Islander individuals had the lowest. Black or African American individuals experienced the steepest increase during 2018-2021 (APC, +16.54%). Rates were highest in the West, increased longest in the South, and remained higher in nonmetropolitan than metropolitan areas. Conclusion: IHD mortality among adults with AUD increased substantially over the study period, accelerating during the COVID-19 pandemic. Marked disparities among men, American Indian or Alaska Native and Black or African American individuals, younger adults, and rural populations highlight the need for integrated cardiovascular and addiction care.