AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Title: Rising Trends in Cardiovascular Disease Mortality with Sleep Disorder as a Contributing Cause of Death: A National Analysis, United States 1999-2020
By Kaur M, Trivedi Y, Sandhu DS et al.
Background/Introduction: Sleep disorders are increasingly recognized as independent risk factors for cardiovascular disease (CVD). Despite growing evidence linking sleep pathology to adverse cardiac outcomes, population-level trends in CVD mortality where sleep disorder serves as a contributing cause of death remain poorly characterized. Understanding these temporal trends and demographic disparities is essential for targeted public health interventions. Methods: We analyzed death certificate data from the CDC WONDER Multiple Cause of Death database (1999-2020) for CVD deaths with sleep disorder listed as a contributing cause. Age-adjusted mortality rates (AAR) per 100,000 population were calculated. Annual percent change (APC) was estimated via log-linear regression. Joinpoint regression identified inflection points in trend trajectories. Poisson regression modeled incidence rate ratios (IRR). Mann-Kendall test confirmed monotonic trend significance. Analyses were stratified by sex, race/ethnicity, Hispanic origin, census region, 2013 urbanization classification, and 10-year age group. Results: From 1999 to 2020, 81,855 CVD deaths listed sleep disorder as a contributing cause. Deaths rose from 1,067 in 1999 to 8,335 in 2020 (+681%), with AAR increasing from 0.4 to 2.0 per 100,000 (+400%). Overall APC was +7.0% (95%CI: 6.6-7.5%, p<0.001; Mann-Kendall Z=6.26, p<0.001). Poisson regression confirmed an IRR of 1.083 per year (95%CI: 1.082-1.085). Joinpoint analysis identified a significant inflection at 2006: APC was steeper during 1999-2005 (+11.1%, 95%CI: 8.2-14.0%) than 2006-2020 (+6.5%, 95%CI: 6.0-6.9%). A sharp acceleration occurred in 2020, with deaths rising +17.3% over 2019, coinciding with the COVID-19 pandemic. By sex, females showed higher APC (+7.95%) than males (+7.33%). Among racial groups, White individuals had the highest APC (+8.8%), followed by American Indian/Alaska Native (+8.3%), Asian/Pacific Islander (+7.7%), and Black/African American (+6.1%). Rural populations (NonCore nonmetro) had the highest APC (+9.4%) versus Large Central Metro (+7.2%). By region, the Midwest (+9.3%) and West (+9.1%) showed the steepest increases. The 85+ age group had the highest APC (+11.6%), with a clear gradient of increasing APC with advancing age (35-44 yrs: +4.5%; 65-74 yrs: +7.0%). Conclusions: CVD mortality with sleep disorder as a contributing cause increased dramatically across all demographic subgroups over two decades, with disproportionate burdens in rural communities, older adults, White individuals, and Midwest/Western regions. The COVID-19 pandemic further accelerated this trend. These findings underscore the urgent need for sleep disorder screening and management integrated into cardiovascular prevention strategies, particularly in underserved and rural populations.