Abstract Body: Background: Despite advances in HIV treatment, cardiac arrest remains a significant cause of mortality in people with HIV. However, national trends and disparities in cardiac arrest mortality associated with HIV in the United States (U.S.) remain understudied.

Research Question: What are the trends and demographic disparities in cardiac arrest mortality associated with HIV among U.S. adults from 2004 to 2023?

Aim: To examine trends and sociodemographic disparities in cardiac arrest mortality associated with HIV among U.S. adults from 2004 to 2023.

Methods: We retrospectively analyzed the CDC WONDER database for adults aged ≥25 years between 2004 and 2023, where both cardiac arrest (ICD-10: I46) and HIV (ICD-10: B20–B24) were listed as causes of death. Age-adjusted mortality rates (AAMRs) were extracted per 100,000 persons. Annual percent change (APC) and average annual percent change (AAPC) were calculated using Joinpoint regression analysis, stratified by year, sex, race/ethnicity, and geographic region.

Results: Between 2004 and 2023, 28,231 deaths were attributed to cardiac arrest associated with HIV among U.S. adults aged ≥25 years. The AAMR decreased from 1.2 in 2004 to 0.41 in 2023, with an AAPC of –5.48 (95% CI: –6.72 to –4.23; p < 0.0001). An initial steep decline was observed from 2004 to 2012 (APC: –9.93; p < 0.000001), followed by a modest decrease from 2012 to 2023 (APC: –2.12; p = 0.016). Men had a higher AAMR (0.96) than women (0.36), with a greater decline in women (AAPC: –6.34; p < 0.000001) compared to men (AAPC: –5.20; p < 0.000001). Racial disparities were evident, with Non-Hispanic (NH) Blacks having the highest AAMR (2.92), followed by Hispanics (0.84) and NH Whites (0.25). Regionally, the Northeast had the highest AAMR (1.2) and experienced the most significant decline (AAPC: –7.66; p < 0.000001), while the Midwest recorded the lowest AAMR (0.15). Metropolitan areas had slightly higher AAMRs (0.76) than nonmetropolitan areas (0.31). Most deaths occurred in medical facilities (67.8%), followed by at-home deaths (14.5%) and deaths in nursing homes or long-term care settings (11%).

Conclusion: Cardiac arrest mortality associated with HIV has significantly declined from 2004 to 2023 across the U.S. However, disparities persist, with greater burdens observed among men, Non-Hispanic Black individuals, and residents of the South and metropolitan areas, emphasizing the need for targeted public health strategies.