Trends in peripheral vascular disease–related mortality among U.S. adults with co-listed hypertension and type 2 diabetes, 1999–2023
TL;DR
The overall AAMR declined substantially over the 25-year study period, with the most pronounced reductions occurring in the mid-2000s, followed by a marked deceleration after 2019, which highlighted the need for targeted equitable access to guideline-directed vascular care.
Abstract
Peripheral vascular disease (PVD) represents a major component of cardiovascular disease and is associated with substantial functional impairment and healthcare costs. However, long-term national trends in PVD-related mortality among adults aged 45 years and older, particularly those with comorbid hypertension and diabetes (PVD-HD), have not been comprehensively described. This study aimed to quantify temporal trends in PVD-HD-related mortality and evaluate sociodemographic and geographic disparities. We used mortality data from the Centers for Disease Control and Prevention (CDC) WONDER database, including death records from 1999 through 2023 for United States (US) residents aged ≥ 45 years. PVD-HD-related deaths were identified when peripheral vascular disease was recorded on the death certificate using ICD-10 codes (I70–I78, I80, and I83) and co-listed essential hypertension (I10) and type 2 diabetes mellitus (E11). We calculated age-adjusted mortality rates (AAMR) per 100,000 population. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). A total of 785,358 PVD-HD-related deaths were identified over the study period. The overall AAMR declined substantially over the 25-year study period, with the most pronounced reductions occurring in the mid-2000s, followed by a marked deceleration after 2019 (Table 1, Figure 1). The steepest decrease occurred during 2003–2009, followed by a slower decline during 2009–2019. After 2019, the trend was not statistically significant. In 2023, non-Hispanic Black/African American individuals had the highest AAMR (24.23), whereas Hispanic/Latino individuals had the lowest (11.84). Geographic disparities persisted, with approximately a twofold difference in state-level AAMR in 2023 (West Virginia highest: 27.90; Louisiana lowest: 13.86). Between 1999 and 2023, PVD-HD-related mortality among U.S. adults aged 45 years and older declined markedly, but the rate of improvement slowed in recent years. Persistent disparities by sex, race/ethnicity, geography, and rurality highlight the need for targeted equitable access to guideline-directed vascular care.