Trends in Mortality Co‑Reporting Heart Failure and Metabolic Syndrome–Related Conditions Among U.S. Adults Aged ≥25 Years, 1999–2023: A CDC WONDER Analysis

Abstract

Background
Heart failure frequently coexists with cardiometabolic conditions commonly associated with metabolic syndrome. Characterizing long-term mortality patterns involving these co-reported conditions may help identify populations with a disproportionate burden.

Methods
We performed a national serial cross‑sectional analysis using the CDC WONDER Multiple Cause of Death database to examine mortality among U.S. adults aged ≥25 years from 1999 to 2023. Eligible deaths included those with at least one heart failure ICD‑10 code and at least one metabolic syndrome–related ICD–10 code recorded anywhere on the death record. Age‑adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Temporal trends were assessed using Joinpoint regression and stratified by sex, race/ethnicity, U.S. Census region, urbanization (1999–2020), and state.

Results
A total of 1,562,715 deaths co‑reporting heart failure and metabolic syndrome–related conditions were identified. The overall AAMR increased from 24.7 in 1999 to 38.3 in 2023. After declining from 2005 to 2012, mortality increased beginning in the mid-2010s, with a pronounced acceleration during 2018–2021 and a modest decline thereafter. AAMRs were higher among men, non-Hispanic Black and American Indian or Alaska Native populations, residents of the Midwest (with comparatively elevated rates also observed in the West and South), and individuals in nonmetropolitan areas.

Conclusions
Mortality involving deaths co‑reporting heart failure and metabolic syndrome–related conditions increased substantially after 2012, with marked disparities by sex, race/ethnicity, geography, and urbanization, underscoring the need for equity‑focused cardiometabolic prevention strategies.