Mortality Trends for Aortic Aneurysm Rupture in the United States, 1999-2020: A Population-Based Observational Study...

Ruptured aortic aneurysm (rAA) is a life-threatening vascular emergency, often fatal before reaching medical care. Despite advances in screening, endovascular repair, and cardiovascular risk control, mortality from rAA remains high. This study aimed to evaluate national trends and disparities in rAA-related mortality among the US adults from 1999 to 2020.

A retrospective population-based analysis was performed using Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research mortality data for adults aged ≥25 years. Deaths were identified using International Statistical Classification of Diseases and Related Health Problems, 10th revision codes I71.1, I71.3, I71.5, and I71.8. Age-adjusted mortality rates (AAMR) per 100,000 were calculated using the 2000 US standard population. Temporal trends were assessed with Joinpoint regression to estimate annual percent change and average annual percent change (AAPC) with 95% confidence intervals.

rAA led to 118,211 deaths in the United States from 1999 to 2020. The overall AAMR was 2.50 per 100,000, declining from 4.87 in 1999 to 1.15 in 2020 (AAPC = -6.51%). Mortality was higher in men (3.70) than women (1.62) and in rural (3.04) compared to urban areas (2.37). Non-Hispanic (NH) Whites had the highest rates (2.74), while NH Asians showed the steepest decline (AAPC = -7.02%). Regionally, the Midwest recorded the highest AAMR (2.94), whereas the Northeast showed the fastest decline (AAPC = -6.83%). Mortality increased sharply with age, peaking in adults ≥85 years.

The US mortality due to rAA has decreased significantly over a period of 20 years, although the underlying factors for this decline cannot be determined from mortality data alone. Nevertheless, this reduction was not even, as women, older adults, and rural residents continue to face disproportionately higher mortality. Ongoing surveillance and targeted efforts to address disparities in access to care are needed to maintain and extend these gains.