AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Rising Mortality from Aortic Aneurysm and Dissection Among Smokers in the United States: A 25-Year Analysis of Trends and Disparities
By Amin Z, Shah SU, Naufil SI et al.
Background: Smoking is one of the strongest modifiable risk factors for aortic aneurysm and dissection and contributes substantially to aortic disease-related morbidity and mortality. Understanding long-term mortality trends and disparities among smokers may help identify high-risk populations and guide prevention efforts. Research Question: How have mortality rates related to aortic aneurysm/dissection among U.S. adults with smoking-related mortality changed over time, and do these trends differ by sex, age, race/ethnicity, and geographic location? Methods We analyzed CDC WONDER mortality data from 1999-2024 for U.S. adults aged ≥25 years with aortic aneurysm/dissection (ICD-10: I71.X) and smoking-related mortality (ICD-10: F17, T65.2) listed on death certificates. Age-adjusted mortality rates (AAMRs) were stratified by sex, age group, race/ethnicity, census region, and urbanization status (1999-2020 for urbanization status). Temporal trends were assessed using Joinpoint regression and annual percent changes (APCs). Statistical significance was defined as p<0.05. Results: A total of 57,170 aortic aneurysm/dissection-related deaths among smokers were identified. Mortality increased during the early study period among women (APC, 32.6%, p<0.05, 1999-2006) and men (APC, 42.5%, p<0.05, 1999-2005), followed by slower but persistent increases through 2024. Men had higher mortality than women (AAMR: 7.1 vs. 3.2 per 100,000). From 2005-2024, mortality increased among men (APC, 1.40%, p<0.05) and women (APC, 0.63%, p<0.05). Mortality was highest among older adults, with marked increases from 1999-2005 (APC, 40.8%, p<0.05) and continued increases through 2012. White individuals had the highest mortality burden, followed by Black/African American, Hispanic, and Asian/Pacific Islander populations. Mortality was higher in non-metropolitan than metropolitan areas (AAMR: 6.1 vs. 4.2 per 100,000). The Midwest had the highest mortality burden, followed by the Northeast, West, and South, with recent increases across all census regions (Figure 1). Conclusions: Mortality related to aortic aneurysm and dissection among smokers increased substantially from 1999 to 2024. Men, older adults, non-metropolitan residents, and Midwest populations experienced the greatest mortality burden. These findings underscore the need for targeted smoking cessation initiatives, early detection of aortic disease, and equitable prevention strategies in high-risk populations.