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Peer-reviewedCC BYCureus

Heart Failure Mortality Before and After COVID-19: Demographic Variations and Urbanization Patterns in the United States (2018-2023).

  • Andrew López Sánchez1
  • Lissett Ferrer Orozco2
  • Elmer D Perez Valdivia3
  • Francisco J Santana Mercedes4
  • Aitor J Roche Perez5
  • Carmen Soler Martin1
  • Gabriela Montano Diaz6
  • Yanisleidy Valladares Urquiza7
  • Javier Peña Angel8
  • Dailyn Rivera Hernández9
  • Mailyn Marrero Herrera1
  • Carlos Acosta-Batista10,11
11 affiliations
  1. 1Internal Medicine, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.
  2. 2Cardiology, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.
  3. 3Intensive Care Unit, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.
  4. 4Geriatrics, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.
  5. 5Internal Medicine, Iditalya 10 Medical Center, Tampa, USA.
  6. 6Primary Care, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.
  7. 7Internal Medicine and Hematology, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.
  8. 8Radiology, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.
  9. 9Psychiatry, Larkin Community Hospital, Miami, USA.
  10. 10Clinical Research, Primary Care - Research Initiative (PCRI), Miami Lakes, USA.
  11. 11Research and Development, Tricocenter Miami, Miami Lakes, USA.
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Abstract

Contemporary evidence on heart failure (HF) recorded as the underlying cause of death remains fragmented across demographic groups and levels of urbanization. The 2018-2023 interval includes two years before the emergence of COVID-19 (2018-2019) and four years after its emergence (2020-2023). We aim to characterize the national underlying cause of HF mortality among US adults aged 45 years or older from 2018 through 2023; describe differences by sex, age, race, and Hispanic origin; and quantify changes in absolute death counts across the six National Center for Health Statistics (NCHS) urbanization categories. We hypothesized that the national age-adjusted HF mortality rate would increase and that demographic differences and variation in geographic death counts would persist. This retrospective, population-based, serial cross-sectional study used Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Underlying Cause of Death data (International Classification of Diseases, 10th Revision (ICD-10) I50). Age-adjusted mortality rates (AAMRs) per 100,000 were evaluated overall and across demographic groups; age-specific crude rates were used for age groups. Zero-joinpoint log-linear models estimated annual percent change (APC) for the overall population, race categories, and Hispanic-origin categories. Race and Hispanic origin were analyzed separately and may overlap. Urbanization analyses used death counts and percentage changes; urbanization-specific population-adjusted rates were not estimated. Deaths listing HF only as a contributing cause were outside the case definition. There were 512,960 deaths with HF as the underlying cause; the aggregate AAMR was 59.6 per 100,000. No statistically significant overall temporal trend was detected (APC: 0.59%; 95% confidence interval (CI): -0.37 to 1.57; p = 0.227). Men had a higher aggregate AAMR than women (68.1 versus 53.0), and Black adults had the highest racial AAMR (70.9). Asian adults had a lower aggregate AAMR than White and Black adults (22.9); Hispanic adults had a lower AAMR than non-Hispanic adults (35.2 versus 61.9). In their respective analyses, Asian and Hispanic groups had increasing trends at the nominal 0.05 significance level (APC: 1.30%, p = 0.047, and 1.96%, p = 0.030, respectively). Age-specific mortality increased sharply with age. Death counts increased across all six urbanization categories, most in Medium Metro counties (+11.0%). No statistically significant national trend was detected during 2018-2023, while descriptive demographic differences and nominally significant increases in the Asian race and Hispanic-origin analyses were observed. These separate analyses do not establish differences between subgroup slopes or narrowing mortality gaps. Geographic findings describe absolute burden, not population-adjusted risk. The results concern HF as the underlying cause and do not measure total HF-associated mortality.

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Cite

BibTeXRIS
BibTeX
@article{sanchez2026heart,
  title = {{Heart Failure Mortality Before and After COVID-19: Demographic Variations and Urbanization Patterns in the United States (2018-2023).}},
  author = {Andrew López Sánchez and Lissett Ferrer Orozco and Elmer D Perez Valdivia and Francisco J Santana Mercedes and Aitor J Roche Perez and Carmen Soler Martin and Gabriela Montano Diaz and Yanisleidy Valladares Urquiza and Javier Peña Angel and Dailyn Rivera Hernández and Mailyn Marrero Herrera and Carlos Acosta-Batista},
  journal = {Cureus},
  year = {2026},
  month = oct,
  doi = {10.7759/cureus.117568},
  url = {https://europepmc.org/article/MED/42996381},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Heart Failure Mortality Before and After COVID-19: Demographic Variations and Urbanization Patterns in the United States (2018-2023).
AU  - Andrew López Sánchez
AU  - Lissett Ferrer Orozco
AU  - Elmer D Perez Valdivia
AU  - Francisco J Santana Mercedes
AU  - Aitor J Roche Perez
AU  - Carmen Soler Martin
AU  - Gabriela Montano Diaz
AU  - Yanisleidy Valladares Urquiza
AU  - Javier Peña Angel
AU  - Dailyn Rivera Hernández
AU  - Mailyn Marrero Herrera
AU  - Carlos Acosta-Batista
PY  - 2026
DA  - 2026/10/06
JO  - Cureus
DO  - 10.7759/cureus.117568
UR  - https://europepmc.org/article/MED/42996381
AB  - Contemporary evidence on heart failure (HF) recorded as the underlying cause of death remains fragmented across demographic groups and levels of urbanization. The 2018-2023 interval includes two years before the emergence of COVID-19 (2018-2019) and four years after its emergence (2020-2023). We aim to characterize the national underlying cause of HF mortality among US adults aged 45 years or older from 2018 through 2023; describe differences by sex, age, race, and Hispanic origin; and quantify changes in absolute death counts across the six National Center for Health Statistics (NCHS) urbanization categories. We hypothesized that the national age-adjusted HF mortality rate would increase and that demographic differences and variation in geographic death counts would persist. This retrospective, population-based, serial cross-sectional study used Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Underlying Cause of Death data (International Classification of Diseases, 10th Revision (ICD-10) I50). Age-adjusted mortality rates (AAMRs) per 100,000 were evaluated overall and across demographic groups; age-specific crude rates were used for age groups. Zero-joinpoint log-linear models estimated annual percent change (APC) for the overall population, race categories, and Hispanic-origin categories. Race and Hispanic origin were analyzed separately and may overlap. Urbanization analyses used death counts and percentage changes; urbanization-specific population-adjusted rates were not estimated. Deaths listing HF only as a contributing cause were outside the case definition. There were 512,960 deaths with HF as the underlying cause; the aggregate AAMR was 59.6 per 100,000. No statistically significant overall temporal trend was detected (APC: 0.59%; 95% confidence interval (CI): -0.37 to 1.57; p = 0.227). Men had a higher aggregate AAMR than women (68.1 versus 53.0), and Black adults had the highest racial AAMR (70.9). Asian adults had a lower aggregate AAMR than White and Black adults (22.9); Hispanic adults had a lower AAMR than non-Hispanic adults (35.2 versus 61.9). In their respective analyses, Asian and Hispanic groups had increasing trends at the nominal 0.05 significance level (APC: 1.30%, p = 0.047, and 1.96%, p = 0.030, respectively). Age-specific mortality increased sharply with age. Death counts increased across all six urbanization categories, most in Medium Metro counties (+11.0%). No statistically significant national trend was detected during 2018-2023, while descriptive demographic differences and nominally significant increases in the Asian race and Hispanic-origin analyses were observed. These separate analyses do not establish differences between subgroup slopes or narrowing mortality gaps. Geographic findings describe absolute burden, not population-adjusted risk. The results concern HF as the underlying cause and do not measure total HF-associated mortality.
SN  - 2168-8184
ER  -