Stalled progress and emerging disparities in acute myocardial infarction mortality among U.S. older adults (> 65 Years) with renal failure, 1999–2023
Abstract Background Older adults with chronic kidney disease (CKD) experience disproportionately high mortality after acute myocardial infarction (AMI). Contemporary national trends—and their variation across demographic and geographic strata remain poorly defined. Methods Using the CDC WONDER Multi...
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BMC
2025-08-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-025-05049-0 |
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| author | Bazil Azeem Yumna Fatima Iffat Ambreen Magsi Hamza Ali Hasnain Sheikh Muhammad Qasim Muhammad Abdullah Naveed Rabia Asim Muhammad Basit Azeem Tazheen Saleh Muhammad Mata-e-Alla Doggar Junaid Imran Ibrahim Nagmeldin Hassan Hamza Ashraf |
| author_facet | Bazil Azeem Yumna Fatima Iffat Ambreen Magsi Hamza Ali Hasnain Sheikh Muhammad Qasim Muhammad Abdullah Naveed Rabia Asim Muhammad Basit Azeem Tazheen Saleh Muhammad Mata-e-Alla Doggar Junaid Imran Ibrahim Nagmeldin Hassan Hamza Ashraf |
| author_sort | Bazil Azeem |
| collection | DOAJ |
| description | Abstract Background Older adults with chronic kidney disease (CKD) experience disproportionately high mortality after acute myocardial infarction (AMI). Contemporary national trends—and their variation across demographic and geographic strata remain poorly defined. Methods Using the CDC WONDER Multiple Cause-of-Death files, we identified U.S. decedents ≥ 65 years in whom ICD-10 codes for AMI and renal failure appeared anywhere on the death certificate between 1999 and 2023. Age-adjusted mortality rates (AAMRS) per 100,000 population were standardized to the 2000 U.S. census. Joinpoint regression quantified annual per cent change (APC) and inflexion points overall and by sex, race/ethnicity, census region, state, and urban–rural status. Results Among 288,801 AMI-related renal-failure deaths, the AAMR fell from 42.1 in 1999 to 18.5 in 2023. Mortality declined steadily from 1999–2012 (APC − 3.39%; 95% CI − 4.25 to − 1.16) and more sharply from 2012–2015 (APC − 17.82%; 95% CI − 22.98 to − 6.99), but rose thereafter (2015–2023 APC + 3.01%; 95% CI − 0.21 to 16.30). Men carried persistently higher rates than women (overall AAMR 39.2 vs 21.2). Non-Hispanic Black adults had the greatest burden (AAMR 35.8), followed by non-Hispanic American Indian/Alaska Native (34.7) and Asian/Pacific Islander patients (34.2); non-Hispanic White adults had the lowest (26.4). From 2020–2023, AAMRs rebounded across most groups and surged 85% among Asian/Pacific Islanders. Regionally, the South recorded the highest AAMR (28.8), and state-level rates ranged three-fold (Utah 14.5 to Rhode Island 43.0). Non-metropolitan counties consistently exceeded metropolitan areas (34.5 vs 28.1). Conclusions Two decades of improvement in AMI mortality among older adults with renal failure have stalled, with a worrisome upturn since 2015 and widening disparities by sex, race, geography, and rurality. These findings underscore the need for cardiovascular-kidney-metabolic–focused prevention, equitable access to acute cardiac care, and tailored post-AMI management to avert further excess deaths in this growing high-risk population. Graphical abstract Central illustration depicting trends in demographics anddisparities in Acute Myocardial Infarction-related Mortality amongadults with Renal Failure patients in the United States from 1999to 2023. |
| format | Article |
| id | doaj-art-83add7fde4cf48a39518f44d26643c33 |
| institution | Kabale University |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-83add7fde4cf48a39518f44d26643c332025-08-20T03:42:37ZengBMCBMC Cardiovascular Disorders1471-22612025-08-0125111010.1186/s12872-025-05049-0Stalled progress and emerging disparities in acute myocardial infarction mortality among U.S. older adults (> 65 Years) with renal failure, 1999–2023Bazil Azeem0Yumna Fatima1Iffat Ambreen Magsi2Hamza Ali Hasnain Sheikh3Muhammad Qasim4Muhammad Abdullah Naveed5Rabia Asim6Muhammad Basit Azeem7Tazheen Saleh Muhammad8Mata-e-Alla Doggar9Junaid Imran10Ibrahim Nagmeldin Hassan11Hamza Ashraf12Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Internal Medicine, Dow Medical College, Dow University of Health SciencesDepartment of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College LyariDepartment of Medicine, Faculty of Medicine, University of KhartoumDepartment of Medicine, Allama Iqbal Medical CollegeAbstract Background Older adults with chronic kidney disease (CKD) experience disproportionately high mortality after acute myocardial infarction (AMI). Contemporary national trends—and their variation across demographic and geographic strata remain poorly defined. Methods Using the CDC WONDER Multiple Cause-of-Death files, we identified U.S. decedents ≥ 65 years in whom ICD-10 codes for AMI and renal failure appeared anywhere on the death certificate between 1999 and 2023. Age-adjusted mortality rates (AAMRS) per 100,000 population were standardized to the 2000 U.S. census. Joinpoint regression quantified annual per cent change (APC) and inflexion points overall and by sex, race/ethnicity, census region, state, and urban–rural status. Results Among 288,801 AMI-related renal-failure deaths, the AAMR fell from 42.1 in 1999 to 18.5 in 2023. Mortality declined steadily from 1999–2012 (APC − 3.39%; 95% CI − 4.25 to − 1.16) and more sharply from 2012–2015 (APC − 17.82%; 95% CI − 22.98 to − 6.99), but rose thereafter (2015–2023 APC + 3.01%; 95% CI − 0.21 to 16.30). Men carried persistently higher rates than women (overall AAMR 39.2 vs 21.2). Non-Hispanic Black adults had the greatest burden (AAMR 35.8), followed by non-Hispanic American Indian/Alaska Native (34.7) and Asian/Pacific Islander patients (34.2); non-Hispanic White adults had the lowest (26.4). From 2020–2023, AAMRs rebounded across most groups and surged 85% among Asian/Pacific Islanders. Regionally, the South recorded the highest AAMR (28.8), and state-level rates ranged three-fold (Utah 14.5 to Rhode Island 43.0). Non-metropolitan counties consistently exceeded metropolitan areas (34.5 vs 28.1). Conclusions Two decades of improvement in AMI mortality among older adults with renal failure have stalled, with a worrisome upturn since 2015 and widening disparities by sex, race, geography, and rurality. These findings underscore the need for cardiovascular-kidney-metabolic–focused prevention, equitable access to acute cardiac care, and tailored post-AMI management to avert further excess deaths in this growing high-risk population. Graphical abstract Central illustration depicting trends in demographics anddisparities in Acute Myocardial Infarction-related Mortality amongadults with Renal Failure patients in the United States from 1999to 2023.https://doi.org/10.1186/s12872-025-05049-0Acute myocardial infarctionChronic kidney diseaseCDC WONDEREpidemiology |
| spellingShingle | Bazil Azeem Yumna Fatima Iffat Ambreen Magsi Hamza Ali Hasnain Sheikh Muhammad Qasim Muhammad Abdullah Naveed Rabia Asim Muhammad Basit Azeem Tazheen Saleh Muhammad Mata-e-Alla Doggar Junaid Imran Ibrahim Nagmeldin Hassan Hamza Ashraf Stalled progress and emerging disparities in acute myocardial infarction mortality among U.S. older adults (> 65 Years) with renal failure, 1999–2023 BMC Cardiovascular Disorders Acute myocardial infarction Chronic kidney disease CDC WONDER Epidemiology |
| title | Stalled progress and emerging disparities in acute myocardial infarction mortality among U.S. older adults (> 65 Years) with renal failure, 1999–2023 |
| title_full | Stalled progress and emerging disparities in acute myocardial infarction mortality among U.S. older adults (> 65 Years) with renal failure, 1999–2023 |
| title_fullStr | Stalled progress and emerging disparities in acute myocardial infarction mortality among U.S. older adults (> 65 Years) with renal failure, 1999–2023 |
| title_full_unstemmed | Stalled progress and emerging disparities in acute myocardial infarction mortality among U.S. older adults (> 65 Years) with renal failure, 1999–2023 |
| title_short | Stalled progress and emerging disparities in acute myocardial infarction mortality among U.S. older adults (> 65 Years) with renal failure, 1999–2023 |
| title_sort | stalled progress and emerging disparities in acute myocardial infarction mortality among u s older adults 65 years with renal failure 1999 2023 |
| topic | Acute myocardial infarction Chronic kidney disease CDC WONDER Epidemiology |
| url | https://doi.org/10.1186/s12872-025-05049-0 |
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