Nationwide analysis of mortality trends in dyslipidemia and peripheral artery disease in the United States of America: a two-decade study of demographic and geographic disparities

Abstract Background Peripheral artery disease (PAD) is a highly prevalent atherosclerotic disorder associated with significant long-term disability, morbidity, and mortality, with over 80% of affected individuals also having dyslipidemia (DL). Global PAD prevalence increased dramatically from an estimated 65.8 million cases in 1990 to 113.4 million in 2019, accounting for approximately 0.13% of all global deaths worldwide. Purpose We hypothesize that there are disparities in mortality due to DL and PAD in the United States of America (USA) based on age, gender, race, and census region. Methods We analyzed adult (≥25 years) death certificates from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC-WONDER) database with DL (ICD-10 codes: E78.1 to E78.9) associated PAD (ICD-10 codes: I70) as multiple causes of death from 1999-2020. Age-adjusted mortality rates (AAMR) per 100,000 population were stratified by gender, race, census region, and year, while crude mortality rates (CMR) were calculated for age groups. Temporal trends were assessed using Joinpoint Regression Program to calculate annual percent changes (APC) and average annual percent changes (AAPC) across demographic and regional subgroups including urban-rural classifications. Results Between 1999-2020, a total of 119,460 deaths occurred in the study population. Mortality attributable to DL and PAD has demonstrated a significant upward trend over the past two decades, with the sharpest rise from 1999 to 2001 (APC: 30.6; 95% CI: 19.4, 42.7; p0.0001) and a notable increase from 2018 to 2020 (APC: 14.5; 95% CI: 9.9, 19.3; p0.0001). Males had higher AAMR than females, 51.7(95% CI: 7.8 to 9.5) vs. 30.0 (95% CI: 1.3 to 3.6), respectively. Women exhibited a steeper APC (15.4; 95% CI: 2.1, 30.5; p=0.02) than men (13.8; 95% CI: 7.2, 20.7; p0.0001) during 2018–2020, despite lower overall rates. The 85+ age group experienced the highest mortality burden. Racial disparities were evident, with Hispanics showing the highest average APC, followed by Non-Hispanic Blacks, Whites, and Asian or Pacific Islanders. Non-Hispanic Blacks had the steepest rise from 2018 to 2020 (APC: 18.5; 95% CI: 7.9, 30.1; p0.0001). Notably, non-metropolitan regions saw a slightly higher AAPC (7.5; 95% CI: 4.8, 9.7; p0.0001) compared to metropolitan areas. Conclusion DL- and PAD-related mortality has plateaued in recent years, with significant disparities across demographic and geographic groups. Women, older adults, and racial/ethnic minorities experienced the steepest increases in mortality. These findings highlight the need for targeted interventions addressing healthcare access, resource allocation, and risk factors in high-risk populations to reduce disparities and improve outcomes.Figure 1.