Abstract Body: Background: Pulmonary heart disease (PHD), often driven by chronic pulmonary vascular remodeling (ICD-10: I27), represents a critical and under-recognized cause of cardiopulmonary mortality in the U.S. While aggregate national trends show a slow rise, this masks acute, multi-level socio-geographic inequalities in risk.
Method: U.S. mortality data (ICD-10: I27) for 2018–2023 was extracted from CDC WONDER to estimate PHD deaths. Racial disparities were quantified using Average Annual Percent Change (AAPC) via log-linear regression, stratified by race, age, gender, Hispanic origin, education attainment, U.S. Census region, and 2013 urbanization classification
Results: Overall AAPC acceleration was driven by Asian and Pacific Islander (API) populations: Filipino (+12.82%), Vietnamese (+9.44%), and Asian Indian (+6.91%), contrasting sharply with overall declines for White (–4.84%) and Black (–3.60%) groups. Intersecting disparities were stark. By Region/Urbanization, the steepest rises were among Western Other Pacific Islanders (+50.0%), Southern Filipinos (+19.98%), and Asian Indians in large central metros (+14.85%), while Blacks in non-core rural areas declined (–0.92%). By Age/Education, the highest AAPC was found in Asian Indians aged 65–74 (+15.39%) and Non-Hispanic Filipinos with some college (+30.93%). Conversely, Black adults aged 85+ (–13.28%) and Chinese with bachelor’s degrees (–27.78%) showed significant mortality compression.
Conclusions: PHD mortality is not uniformly increasing; it is sharply accelerating in structurally marginalized API communities, younger age bands, and those in lower educational strata. These findings underscore the profound role of structural racism, differential care access, and urban-environmental exposure. Urgent disaggregation of national metrics and targeted, upstream preventive strategies for at-risk race-region-education cohorts are required.