Obstructive sleep apnea and rising cerebrovascular disease mortality in the United States, 1999-2020: A retrospective...

The prevalence of obstructive sleep apnea (OSA) in the general population has been rising in recent years. OSA has not only been identified as an independent risk factor for cerebrovascular disease (CVD) but is also associated with major CVD risk factors such as hypertension, obesity, and diabetes. CVD is the second leading cause of death globally, with approximately 165,000 deaths occurring annually in the United States. This study aimed to conduct a retrospective comparative analysis of CVD mortality among adults with OSA in the United States from 1999 to 2020, stratified by gender, race, urbanization, and geographic region.

Age-adjusted mortality rates (AAMR) and crude mortality rates (CMR) per 100,000 population were analyzed using the CDC WONDER multiple causes of death database to assess mortality among individuals aged 25 years and older diagnosed with both OSA (ICD-10: G47.3) and CVD (ICD-10: I60-I69). Joinpoint regression was used to visualize mortality trends and calculate annual percentage change (APC) and average annual percentage change (AAPC).

A total of 14,763 deaths occurred between 1999 and 2020 among individuals diagnosed with both OSA and CVD. The AAMR exhibited an upward trend, increasing from 0.1 in 1999 to 0.7 in 2020, with an AAPC of 8.97% (95% CI: 8.28-9.80). A sharp increase in AAMR was observed from 2014 onward (APC = 13.61%). Patients aged 85 and older had the highest CMR (2.11). Males (AAMR = 0.4) had a higher overall mortality rate than females (AAMR = 0.2). From 1999 to 2015, males experienced a moderate mortality increase (APC = 7.06%), but after 2015, a more pronounced rise was noted (APC = 13.25%), with an AAPC of 8.5% (95% CI: 7.55-9.50). Meanwhile, females showed a steady increase in mortality from 1999 to 2020 (APC = 10.01%) with an AAPC of 10.01% (95% CI: 9.20-11.35). Beyond gender disparities, racial differences were also observed. Non-Hispanic (NH) African Americans had the highest overall AAMR (0.39), followed by NH American Indians (0.31) and NH Whites (0.30). In contrast, NH Asians (0.12) and Hispanics (0.18) had the lowest mortality rates. Urbanization-based classification showed that the highest AAMR occurred in Small Metro (0.40) and Micropolitan areas (0.39), while Large Central Metro (0.24) and Large Fringe Metro (0.26) had the lowest AAMRs. In census regions, the highest AAMR was recorded in the Midwest (0.37) and West (0.36), followed by the South (0.26) and Northeast (0.19). Among U.S. states, Oregon (0.82) and Minnesota (0.76) exhibited the highest AAMRs.

CVD mortality in individuals with OSA exhibited a pronounced upward trajectory, with the highest burden observed among males, patients aged 85 and older, NH African Americans, and small metro residents, highlighting stark demographic and geographic disparities. The disproportionate rise in mortality across gender, racial, and geographic groups warrants proactive diagnostic vigilance and integrated management strategies. Targeted interventions for high-risk populations are essential to curbing this escalating trend. These disparities underscore the urgency of unraveling their underlying drivers, paving the way for more effective and equitable prevention.