Demographic and Regional Trends of Heart Failure-Related Mortality in Young Adults in the US, 1999-2019

Importance: There are limited data on mortality trends in young adults with heart failure (HF). Objective: To study the trends in HF-related mortality among young adults. Design, Setting, and Participants: This retrospective cohort analysis used mortality data of young adults aged 15 to 44 years with HF listed as a contributing or underlying cause of death in the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from January 1999 to December 2019. Analysis took place in October 2021. Exposures: Age 15 to 44 years with HF listed as a contributing or underlying cause of death. Main Outcomes and Measures: HF-related age-adjusted mortality rates (AAMR) per 100000 US population stratified by sex, race and ethnicity, and geographic areas. Results: Between 1999 and 2019, a total of 61729 HF-related deaths occurred in young adults. Of these, 38629 (62.0%) were men and 23460 (38.0%) were women, and 22156 (35.9%) were Black, 6648 (10.8%) were Hispanic, and 30145 (48.8%) were White. The overall AAMR per 100000 persons for HF in young adults increased from 2.36 in 1999 to 3.16 in 2019. HF mortality increased in young men and women, with men having higher AAMRs throughout the study period. AAMR increased for all race and ethnicity groups, with Black adults having the highest AAMRs (6.41 in 1999 and 8.58 in 2019). AAMR for Hispanic adults and White adults increased from 1.62 to 2.04 and 1.83 to 2.45 over the same time period, respectively. Across most demographic and regional subgroups, HF-related mortality stayed stable or decreased between 1999 and 2012, followed by an increase between 2012 and 2019. There were significant regional differences in the burden of HF-related mortality, with states in the upper 90th percentile of HF-related mortality (Oklahoma, South Carolina, Louisiana, Arkansas, Alabama, and Mississippi) having a significantly higher mortality burden compared with those in the bottom tenth percentile. Conclusions and Relevance: Following an initial period of stability, HF-related mortality in young adults increased from 2012 to 2019 in the United States. Black adults have a 3-fold higher AAMR compared with White adults, with significant geographic variation. Targeted health policy measures are needed to address the rising burden of HF in young adults, with a focus on prevention, early diagnosis, and reduction in disparities..