AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
The Changing Landscape of Pulmonary Vascular Mortality in U.S. Women: National Trends, Geographic Shifts, and Demographic Disparities
By Naser K, Trivedi Y, Sandhu DS et al.
Background: Pulmonary heart disease (PHD) and pulmonary vascular disease (PVD) represent a significant but undercharacterized burden in women. National mortality trends across demographic and geographic strata remain poorly described. Methods: Death certificate data for women with PHD/PVD as the underlying cause (ICD-10: I26-I28) were extracted from CDC WONDER (1999-2020). Age-adjusted mortality rates (AAMR) per 100,000 and crude rates were analyzed overall and stratified by race/ethnicity, Hispanic origin, census region, 2013 urbanization level, and 10-year age groups. Annual Percent Change (APC) was calculated via log-linear regression. Joinpoint regression identified inflection points in the overall trend. Statistical significance was set at p<0.05. Results: Among 196,225 PHD/PVD deaths in women over 22 years, the overall AAMR showed a biphasic pattern. Joinpoint analysis identified 2006 as the critical inflection: AAMR declined modestly during 1999-2006 (APC: –0.88%; p=0.14), then increased significantly during 2006-2020 (APC: +1.23%; p<0.001), with AAMR rising from 4.3 to 5.1/100,000 by 2020. Total deaths increased 44.4% (7,875 in 1999 vs. 11,371 in 2020).By race, Black/African American women had the highest crude rates (7.2→9.1/100,000; APC +1.03%, p=0.002). Asian/Pacific Islander women showed the steepest relative increase (APC +2.09%, p<0.001). White women demonstrated a significant rising trend (APC +1.10%, p<0.001). No significant trend was observed in American Indian/Alaska Native women.Geographically, the West had the fastest-rising mortality (APC +1.72%, p<0.001), followed by Midwest (+1.10%, p<0.001). A rural-urban disparity was evident: rural/micropolitan areas showed steeper increases (Micropolitan APC +1.41%; NonCore +1.05%) vs. Large Central Metro (+0.66%), all p<0.05.Age-stratified analysis revealed a protective trend in younger age groups (15-24 years: APC –1.65%, p=0.005; 65-74 years: –1.11%, p<0.001) contrasted by a significant rise in the oldest old (≥85 years: APC +1.92%, p<0.001). Mortality in infants (<1 year) decreased significantly (APC –3.34%, p=0.001). Conclusions: PHD/PVD mortality in U.S. women has risen significantly since 2006, driven by increasing rates in older adults, rural communities, Asian/Pacific Islander women, and Western states. These findings underscore urgent need for targeted surveillance, equitable access to pulmonary care, and sex-specific research in PHD/PVD.