Shifting burdens: heart failure and pneumonia mortality patterns in the United States, 1999-2020

Heart failure (HF) and pneumonia are leading causes of mortality in the United States, yet limited research has examined deaths attributable to their co-occurrence. Understanding demographic and geographic disparities in these mortality trends is critical for guiding public health interventions. Using data from the CDC Wide-ranging Online Data for Epidemiologic Research database, this study analyzed mortality from 1999 to 2020 among individuals aged 25 years and older. Age-adjusted mortality rates (AAMRs) per 100 000 population were calculated by sex, race/ethnicity, region, and rural-urban classification, with temporal trends assessed via Joinpoint regression. A total of 542 805 deaths were attributed to HF and pneumonia. Mortality declined steadily from 1999 through 2019 but rose sharply thereafter. The overall AAMR was 11.4, consistently higher in men than in women. Racial and ethnic disparities were evident: White individuals had the highest AAMR (11.6), followed by Black (10.2), American Indian/Alaska Native (9.6), and Asian/Pacific Islander populations (6.5). Regionally, the Midwest had the highest rate (12.3), and rural areas (15.3) exceeded urban areas (10.5). State-level mortality was greatest in West Virginia, Kentucky, and Oklahoma. These findings highlight a reversal of declining trends and underscore persistent disparities, emphasizing the need for targeted prevention, improved healthcare access, and community-based interventions.