The mortality rate associated with aortic dissection has been increasing in the United States (US) since 2012, especially among women and Black individuals, according to results of a study, published in the Journal of the American Heart Association.
Data for this study were sourced from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) and the Multiple Cause-of-Death Public Use Record database of death certificates. Longitudinal death rates associated with aortic dissection between 1999 and 2019 were evaluated for trends.
During the study period, there were 86,855 deaths associated with aortic dissection in the US. Of those with sufficient information (n=83,803), 81.7% occurred within a medical facility, 13.9% at home, 2.8% in a long-term care facility, and 1.5% in hospice.
The age-adjusted mortality rate (AAMR) was 21.1 per 1,000,000 in 1999 and 21.3 per 1,000,000 in 2019. Between 1999 and 2012, the AAMR was declining, with an annual percent change (APC) of -1.5%. Between 2012 and 2019, it began to increase at an APC of 2.5%.
Stratified by gender, men and women had an AAMR of 28.5 and 15.1 per 1,000,000 in 1999, and 27.2 and 15.7 per 1,000,000 in 2019, respectively. Like the general population, the APC was decreasing then began to increase in 2013 for men (APC, 2.6%) and 2012 for women (APC, 3.1%).
The AAMR for White individuals increased from 20.7 to 20.3 per 1,000,000, for Black individuals from 28.7 to 35.7 per 1,000,000; for Hispanic individuals from 13.4 to 13.6 per 1,000,000; and for other ethnicities from 17.1 to 18.0 per 1,000,000 between 1999 and 2019, respectively. After 2012, the APC increased by 2.6% among the White population and by 4.0% among the Black population. The rate of aortic dissection mortality was stable after 2014 for the Hispanic population and did not change significantly for other ethnicities.
Across the US, AAMR varied from 14.3 per 1,000,000 in Massachusetts to 30.9 per 1,000,000 in the District of Columbia. Connecticut, New Jersey, Kentucky, Virginia, Mississippi, and Massachusetts were associated with the lowest rates and Washington, Kansas, Delaware, Michigan, Hawaii, and the District of Columbia, the highest.
This study was limited by not having access to information about attempted treatments.
“In conclusion, despite an initial decline, we report a concerning increase in [aortic dissection] mortality from 2012 to 2019 in this nationwide population-based analysis of death certificate data,” the researchers wrote. “This increasing mortality is especially pronounced within women, non-Hispanic Black individuals, and older individuals and requires further investigation into the causative mechanisms of these identified disparities for this highly lethal and morbid condition.”
Nazir S, Ariss RW, Minhas AMK, et al. Demographic and regional trends of mortality in patients With aortic dissection in the United States, 1999 to 2019. J Am Heart Assoc. Published online March 18, 2022. doi:10.1161/JAHA.121.024533