Trends and Disparities of CVD Underlying-Cause Deaths with Pneumonia and Influenza Mentioned on the Death Certificate in the United States: A CDC WONDER Analysis.

Abstract

Background: Pneumonia and influenza (P&I) may precipitate cardiovascular decompensation, yet long-term U.S. mortality patterns of P&I co-mention at death among cardiovascular disease (CVD) deaths are not well described across sociodemographic and geographic strata. Methods: Using CDC WONDER multiple-cause-of-death data, we identified deaths with CVD as the underlying cause (ICD-10 I00–I99) and P&I (J09–J18) mentioned anywhere on the death certificate. We calculated crude and age-adjusted mortality rates (AAMR, per 100,000; 2000 U.S. standard), assessed 1999–2023 trends with Joinpoint regression, selected descriptive subgroup and interstate mapping summaries used 1999–2020. Results: AAMR declined from 29.58 (1999) to 8.45 (2023) (-71.4%), with joinpoints in 2005, 2009, and 2019 and a plateau after 2019. Mortality increased with age; adults ≥85 years accounted for 47.3% of deaths and the highest crude rate (277.9 per 100,000). In 2023, AAMR was higher in males than in females (10.69 vs 6.73). Rates were higher in Black than White decedents (10.7 vs 9.5 per 100,000) and highest in rural areas, with marked interstate heterogeneity. Conclusions: AAMRs declined during 1999–2023 but plateaued after 2019, with heterogeneity by age, geography, and race/ethnicity. These descriptive co-mention patterns highlight higher-rate groups and areas that may warrant prioritization for further investigation and prevention planning; they do not establish causal pathways or quantify the impact of structural determinants