Ischemic heart disease mortality with documented tobacco use in the United States, 1999–2023: a nationwide population-based analysis

Abstract

BACKGROUND: Tobacco use is a major risk factor for ischemic heart disease (IHD), substantially increasing the likelihood of myocardial infarction, stroke, and premature mortality. This study examined U.S. trends in IHD mortality with documented tobacco use disorder from 1999 to 2023. METHODS: CDC mortality data for adults aged ≥ 25 years with IHD (ICD-10 codes: I20-I25) and documented tobacco use (ICD-10 code: F17) listed as contributing causes of death were analyzed. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC). RESULTS: From 1999 to 2023, 1,497,919 deaths were reported. The AAMR rose from 3.90 to 32.37 (AAPC: 10.71; p < 0.01). Males had a higher AAMR (39.68; AAPC: 10.72) than females (14.05; AAPC: 10.77). Non-Hispanic (NH) Whites had the highest AAMR (26.86), followed by American Indians (25.43), NH Blacks (19.77), and Hispanics (10.38). The Midwest had the highest regional AAMR (32.96). Most deaths occurred in inpatient facilities (27.9%). Adults aged ≥ 65 years had the highest mortality rate (CMR: 92.16). Rural areas exceeded urban (35.73 vs. 22.95). CONCLUSION: IHD mortality with documented tobacco use has risen sharply, disproportionately affecting older adults, males, rural areas, the Midwest, and NH Whites.