Trends and Projections in Valvular Heart Disease Mortality Among Older Adults in the United States, 1999 to 2040

Valvular heart disease (VHD) contributes substantially to cardiovascular mortality. We evaluated long-term VHD mortality trends among older adults to inform healthcare planning. CDC WONDER mortality data (1999 to 2023) were analyzed for adults aged ≥65 years to calculate age-adjusted mortality rates (AAMRs). Joinpoint regression identified temporal trends, alongside a subtype analysis stratifying AAMRs by nonrheumatic aortic (ICD-10 I35), mitral (ICD-10 I34), tricuspid (ICD-10 I36), and chronic rheumatic (ICD-10 I05 to I09) valve disorders. Age-period-cohort modeling assessed generational effects, and ARIMA models projected mortality rates through 2040. Among 1,204,490 VHD deaths, the AAMR declined from 1999 to 2018 (annual percent change [APC] -0.87) but significantly increased from 2018 to 2023 (APC 1.52). Nonrheumatic aortic valve disorders accounted for the vast majority of deaths, demonstrating a continuous decline (APC -0.20). Tricuspid valve disorders showed a sustained rise (APC 7.30), mitral valve disorders exhibited a biphasic pattern reversing after 2012, and chronic rheumatic diseases showed a post-2017 resurgence. Mortality was highest among non-Hispanic White individuals, men, nonmetropolitan residents, and in the West. Age-period-cohort analysis demonstrated generational divergence: recent cohorts experienced lower mortality at ages 65 to 69, whereas adults aged ≥85 years faced progressively higher risks. Forecasting models project the recent resurgence will transition into a sustained plateau, stabilizing at 109.2 deaths per 100,000 population through 2040. Ultimately, after 2 decades of decline, the VHD mortality trend reversed course and is projected to remain stably elevated. This disproportionate impact among the oldest-old and rural populations underscores the need for targeted strategies to mitigate widening disparities.