Abstract Body: Background:
Tobacco use remains a major modifiable risk factor for coronary artery disease (CAD), amplifying cardiovascular risk when combined with other comorbidities. While cigarette smoking remains prevalent among older adults, the rise of e-cigarette use among younger populations complicates tobacco control efforts.
Hypothesis:
This study aims to evaluate national trends in CAD mortality attributable to tobacco use in U.S. adults aged 25 and older, with an emphasis on demographic and geographic disparities.
Methods:
We conducted a retrospective analysis using CDC WONDER data from 1999 to 2023. Age-adjusted mortality rates (AAMRs) attributable to CAD and tobacco use were calculated across sex, age groups, race/ethnicity, metropolitan status, and U.S. census regions. Joinpoint regression was used to assess changes in trends and estimate annual percent changes (APCs).
Results:
Between 1999 and 2023, there were 901,327 CAD deaths attributed to tobacco use in adults ≥25 years, with males (n=635,157) disproportionately affected. National AAMR increased from 2.6 (95% CI: 2.5–2.7) to 18.8 (95% CI: 18.6–19.0) per 100,000. Sex-stratified analysis showed a greater mortality burden among males, with trends plateauing after 2016. Age-stratified data revealed the highest AAMRs in older adults, peaking at 72.7 in 2021 before declining modestly. Racial disparities persisted, with non-Hispanic White and Black populations experiencing the highest burdens. Non-metropolitan regions consistently exhibited higher mortality rates compared to metropolitan counterparts. Regionally, the South and Midwest showed the steepest increases, while the Northeast and West demonstrated earlier plateauing.
Conclusion:
CAD mortality associated with tobacco use has significantly increased over the past two decades, particularly among males, older adults, and non-metropolitan populations. Racial and regional disparities underscore the urgent need for targeted public health interventions to reduce the cardiovascular burden of tobacco use and promote health equity.