Demographic and regional disparities in acute kidney injury-related heart failure mortality among American adults from 1999 to 2023: A retrospective cohort study using the CDC WONDER database

Background Acute kidney injury (AKI) is increasingly associated with heart failure (HF), contributing to higher morbidity and mortality. Nonetheless, mortality remains under-explored. This study examines trends in AKI-related HF mortality trends among American adults. Methods We sourced data from 1999 to 2023 from the CDC WONDER multiple cause-of-death database for AKI-related HF mortality in adults aged ≥ over 25. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 persons for year and sex from 1999 to 2023 and from 1999 to 2020 for ethnicity, census region, and urbanization status, analyzing annual percent change across these stratifications. Results From 1999 to 2023, 284,599 AKI-related HF deaths occurred, with AAMR rising from 34.42 to 86.53. Between 1999 (34.42) and 2010 (50.5), the AAMRs increased modestly, followed by relative stability until 2019 (46.93); the steepest increase occurred between 2020 (51.52) and 2022 (91.59), with a modest decline observed in 2023 (86.53). Men consistently had higher AAMRs than women. Male AAMRs increased from 43.45 to 108.3, while female rates rose from 29.12 to 69.79. Non-Hispanic (NH) Blacks had the highest AAMR (54.18), followed by NH American Indian/Alaska Natives (52.49), NH Whites (45.74), Hispanics/Latinos (33.38), and NH Asians/Pacific Islanders (26.53). The Midwest had the highest AAMR (49.66), followed by the South (46.24), West (42.85), and Northeast (41.09). Rural areas showed higher AAMRs (56.81) than urban (42.91). North Dakota reported the highest AAMR (69.29), while Florida had the lowest (24.38). Conclusion While overall AAMRs were higher in 2023 compared to 1999, the sharpest rise was seen post-2020 after a period of relative stability from 2010 to 2019. AKI-related HF mortality remains disproportionately high among men, NH Blacks, and residents of the Midwestern and rural United States, highlighting the necessity of focused initiatives to address inequities and lower mortality.