Abstract Body (Do not enter title and authors here): Background:To analyze trends and disparities in ischemic heart disease (IHD) and cerebrovascular disease (CVD) mortality in American adults aged 25 years and older from 1999-2020.

Methods:Retrospective analysis of the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database was conducted. For IHD and CVD, International Classification of Disease-10 codes I20-25 and I60-69, respectively, were used. Age-adjusted mortality rates (AAMRs) and crude death rates (CDRs) per 100,000 persons were calculated. Trends were analyzed using Joinpoint regression to determine average annual percentage change (AAPC). Temporal trends were analyzed in terms of sex, race, geographical distribution, and patient age-related mortality.

Results:A total of 1,008,377 deaths were reported from patients with both IHD and CVD. The overall AAMR was 21.23(AAPC:-3.72;p<0.001). Males had a higher AAMR(25.72 vs 17.92) but a smaller decline in mortality compared to females(AAPC:-3.2 vs -4.38;p<0.001 for both). When stratified by race, the highest AAMR was observed for non-Hispanic (NH) Black/African Americans(26.98), followed by NH Whites (21.08), NH American Indian/Alaskan Native(18.79), Hispanics(16.6), and NH Asian/Pacific Islanders(14.66). All races saw statistically significant declines in AAMR, with the greatest decline noted in NH Asian/Pacific Islanders(AAPC:-4.87;p<0.001). Geographically, the highest AAMR was reported in Midwest(22.02) and South(21.93). AAMRs declined significantly across all census regions, with Northeast experiencing the steepest decrease(AAPC:-4.24;p<0.001). AAMR was disproportionately higher in nonmetropolitan areas(25.25) than metropolitan areas(20.35). Both areas showed significant rates of decline(nonmetropolitan AAPC:-3.16 and metropolitan AAPC:-3.86;p<0.001). CDR was highest in adults aged 85 and older(340.87). A significant decline in mortality was seen for 55-64, 65-74, 75-84, and 85 years and older groups, with the greatest decline seen for 75-84(AAPC:-4.16;p<0.001). All other age groups showed an increase in mortality, albeit not significant.

Conclusion:Despite significant overall decline in IHD and CVD mortality between 1999-2020, notable disparities persist. Males, NH Black, residents of Midwest, and nonmetropolitan areas experienced disproportionately higher mortality rates. These findings highlight the need for targeted public health efforts to reduce mortality in high-risk populations.