Abstract Body (Do not enter title and authors here): Introduction: Congenital Heart Disease (CHD) is the most common birth defect and is significantly associated with mortality in children. This study explores trends in CHD-related mortality among all age groups in the US from 1999-2020 and estimate through 2030.

Methods: Data from CDC WONDER multiple-cause-of-death database was used to analyse trends associated with CHD among patients in the US. Age adjusted mortality rates (AAMR) were reported per 100,000 population and average annual percent change (AAPC) were calculated using the Joinpoint regression program. Trends were assessed by sex, race, age, census region, and urbanization status. Predictive modeling using Python and Seasonal AutoRegressive Integrated Moving Average (SARIMA) was performed to estimate future trends from 2020 to 2030.

Results: There were a total of 117,837 deaths due to CHD in patients in the U.S from 1999-2020. In the overall population, the AAMR steadily decreased from 2.34 in 1999 to 1.62 in 2011 (APC: -3.06; 95 CI%: -3.44, -2.67; p < 0.000001), followed by a slight decrease to 1.59 in 2020 (APC: -0.40; 95 CI%: -1.02, 0.22; p: 0.187) and predicted to decrease further by 2030. Throughout the study period, males demonstrated a higher AAMR than females (males: 1.94; females: 1.61). From 2020 to 2030, it is predicted that the AAMR for males will decrease, and increase for females. Additionally, individuals aged 0-24 years had the highest crude rates at 2.83 and young adults aged 25-44 years had lowest crude rates at 0.75. Among racial groups, Non-Hispanic (NH) Black or African American individuals had the highest AAMR at 2.18, while NH Asian or Pacific Islander individuals had the lowest at 1.15. Statewise, the District of Columbia had the highest AAMR at 2.28 and Massachusetts had the lowest AAMR at 1.25. Regionally, the Midwest exhibited the highest AAMR at 1.91 and the Northeast had the lowest AAMR at 1.50. Rural areas demonstrated a higher AAMR (2.03) than urban areas (1.72) from 1999 to 2020. It is forecasted that rural areas will face a drastic decrease in mortality, whereas mortality in urban areas will increase till 2030.

Conclusion: This study highlights significant disparities in CHD-related mortality in individuals in the U.S. The differences among the demographic factors and geographic regions highlights the need for equitable healthcare access. Addressing disparities in healthcare access, and improving early detection and management of CHD is crucial.