Trends and Disparities in Aortic Aneurysm and Dissection Mortality in the US (1999-2023)

Overview

This study analyzed mortality trends related to aortic aneurysm (AA) and aortic dissection (AD) in the United States from 1999 to 2023 using CDC WONDER data. It identified significant disparities in mortality rates across sex, race/ethnicity, age groups, geographic regions, and urbanization status, highlighting evolving epidemiological patterns and persistent high-risk subgroups.

Background

Aortic aneurysm (AA) and aortic dissection (AD) are serious cardiovascular conditions with distinct pathophysiologies and clinical management strategies. AA is classified anatomically into thoracic and abdominal types, while AD is categorized by the Stanford classification into type A and B, with type A carrying a worse prognosis. Despite advances in diagnosis and treatment, including surgical and endovascular interventions, mortality trends and disparities remain incompletely understood. Prior studies have shown declining mortality for abdominal AA but increasing incidence of thoracic AA, alongside persistent demographic and geographic disparities. AD incidence remains stable with decreasing in-hospital mortality but notable disparities in elderly, male, and minority populations.

Data Highlights

Key Findings

• AA mortality in the US declined from 1999 to 2020 but significant sex, racial/ethnic, and regional disparities persist.
• Thoracic aortic aneurysm incidence has increased substantially, likely due to aging and improved imaging, despite gradual mortality decline.
• Aortic dissection mortality decreased overall from 1999 to 2023, but elderly (≥85 years), males, and minorities remain at higher risk.
• Management advances including pharmacotherapy, open surgery, and endovascular repair have influenced mortality trends differently by disease subtype and patient characteristics.
• Geographic and urbanization-related disparities in mortality highlight the impact of healthcare access and socioeconomic factors.
• Dual analysis of AA and AD reveals both shared and distinct epidemiological patterns important for targeted risk stratification and intervention.

Clinical Implications

Clinicians should recognize that despite overall mortality improvements, vulnerable populations such as elderly patients, males, and ethnic minorities require focused surveillance and tailored management strategies. Understanding regional and urban-rural disparities can guide resource allocation and preventive efforts. Advances in imaging and intervention techniques necessitate updated clinical protocols to optimize outcomes across diverse patient groups.

Conclusion

Mortality related to aortic aneurysm and dissection in the United States has generally declined over the past two decades, yet significant demographic and geographic disparities remain. Comprehensive epidemiological insights from nationwide data support targeted clinical and public health interventions to reduce these disparities and improve patient outcomes.

References

1. CDC WONDER Database -- Mortality Data 1999-2023
2. Clinical Guidelines and Epidemiology References [1-23]