US rheumatic heart disease mortality rose after 2012

Researchers analyzed US Centers for Disease Control and Prevention WONDER death-certificate data from 1968 to 2023, stratifying rheumatic heart disease (RHD) mortality by age, sex, race, ethnicity and urbanisation. Joinpoint and multiple regression analyses were used to assess trends across three ICD coding periods. The study was observational and used aggregate mortality data; it did not assess individual-level risk factors or causes of the observed changes.

RHD mortality declined significantly from 1968 to 2012, then increased. Between 2012 and 2023, annual deaths rose from 3,083 to 4,332; the crude rate increased from 0.98 to 1.29 per 100,000, and the age-adjusted rate from 0.88 to 1.04 per 100,000 (all p<0.0001). Females had higher crude mortality rates than males throughout the study. The share of deaths among people aged 75 or older rose from 17% in 1968 to 61% in 2023. From 2012 to 2023, relative increases were largest among American Indian or Alaska Native people (112.4%) and Hispanic people (60.2%).

The findings describe population-level mortality trends and may help identify groups for further investigation. Death-certificate data cannot establish why mortality increased, and changes in coding across ICD periods are a consideration. The authors reported no specific funding or competing interests.