Abstract Body (Do not enter title and authors here): Background:

Individuals with schizophrenia exhibit elevated mortality rates, notably due to increased heart failure risk. This study examines U.S. mortality data from 1999 to 2020, focusing on age-adjusted mortality rates (AAMRs) by gender, race, urbanization, and region.

Methods:

Utilizing CDC WONDER death certificates (1999–2020), we identified deaths with schizophrenia (ICD-10 F20) and heart failure (ICD-10 I50) as contributing factors. Analyses compared AAMRs across gender, race, urbanization levels, census regions, and states using Joinpoint Regression Program v5.3.0.

Results:

From 1999 to 2020, 7,365 adults with schizophrenia died due to heart failure (3,391 males; 3,974 females). AAMR trends revealed gender disparities: males experienced a decline from 1999–2012 (APC: -2.73), followed by an increase from 2012–2020 (APC: 6.02); females showed a gradual decline from 1999–2016 (APC: -3.91) and a subsequent rise from 2016–2020 (APC: 12.72).

Urbanization analysis indicated that Large Central Metro areas saw decreased AAMRs from 1999–2009 (APC: -5.24) and increased rates from 2009–2020 (APC: 4.88). Large Fringe Metro areas declined from 1999–2012 (APC: -5.83) but rose from 2012–2020 (APC: 6.71). Medium Metro, Micropolitan, and Non-core areas consistently declined from 1999–2020 (APCs: -1.21, -2.12, and -2.17, respectively). Small Metro areas decreased from 1999–2015 (APC: -4.15) and increased from 2015–2020 (APC: 10.26).

Regional disparities were evident: the Northeast declined from 1999–2008 (APC: -9.33) and increased from 2008–2020 (APC: 5.32); the Midwest decreased from 1999–2013 (APC: -4.48) and rose from 2013–2020 (APC: 3.41); the South declined from 1999–2016 (APC: -1.87) and increased from 2016–2020 (APC: 11.02); the West showed a slight increase from 1999–2020 (APC: 0.01).

Racial analysis showed that White individuals' AAMRs decreased from 1999–2012 (APC: -4.53) and increased from 2012–2020 (APC: 4.67). African American individuals experienced a slight decline from 1999–2018 (APC: -0.11) and a significant rise from 2018–2020 (APC: 26.57).

Conclusion:

Heart failure mortality among individuals with schizophrenia is rising, particularly among males and non-urban residents. Targeted public health interventions are essential to address these disparities and reduce mortality in this vulnerable population.