485 Mortality trends in patients with co-occurring heart failure and parkinson’s disease in the United States: a multiple cause of death analysis, 1999-2020

<h3>Introduction</h3> Heart failure and Parkinsonism are chronic, progressive conditions that disproportionately affect older adults and are major contributors to morbidity and mortality in the United States. HF affects an estimated 6.7 million Americans ≥20 years of age, with prevalence projected to rise to over 8.7 million by 2030 and 11.4 million by 2050, and approximately 1 in 4 adults will develop HF in their lifetime. While Parkinson’s remains one of the leading neurological causes of mortality in older adults across America. <h3>Methodology</h3> Mortality data from the CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database were analyzed for adults aged ≥65 years from 1999-2020. Deaths listing congestive heart failure (I50.0), left ventricular failure (I50.1), heart failure (I50.9), and Parkinson’s disease (G20) as underlying or contributing causes were included. Crude and age-adjusted mortality rates (AAMRs) per 100,000 persons were standardized to the 2000 U.S. population, and temporal trends were assessed using Joinpoint regression to estimate annual (APC) and average annual percent changes (AAPC), stratified by age, race/ethnicity, state, and urban-rural status. <h3>Results</h3> From 1999-2020, 68,031 deaths occurred among adults with Heart Failure and Parkinsonism. Age-stratified analysis showed the highest mortality in adults ≥85 years (APC: 6.38; 95% CI: 4.60 to 9.14; p&lt;0.01) and the lowest in 65-74 years (APC: 10.98; 95% CI: 6.73 to 20.03; p&lt;0.01). Sex-wise, males had higher AAMRs than females from 14.1 to 14.2 (1999-2020) vs. 6.6 to 5.7 (1999-2020); females exhibited sharp increase during 2014-2020 (APC: 5.93, 95% CI: 4.23 to 8.52; p&lt;0.01), while males rose 2015-2020 (APC:7.36; 95% CI: 5.92 to 9.74; p&lt;0.01). Race-wise, White Americans had the highest AAMRs; from 9.7 to 9.8 (1999-2020), followed by Hispanics/Latinos; from 5.9 to 5.1 (1999-2020), and Black/African Americans (APC: 7.62; 95% CI: 4.32 to 14.73; p&lt;0.01). Rural noncore areas had the highest mortality, from 10.9 to 11.6 (1999-2020), and large central metros had the lowest, from 7.7 to 7.1 (1999-2020), with a similar trend across micropolitan and other metropolitan areas. Overall mortality rose steadily, with the steepest increase in 2018-2020 (APC: 11.41; 95% CI: 8.01 to 13.77; p&lt;0.01). States with age-adjusted mortality rates at or above the 90th percentile (≥10.1 per 100,000) included Nebraska (14.6), North Dakota (13.3), Minnesota (10.7), Oklahoma (10.7), Mississippi (10.6), and Oregon (10.1) (figures 1 and 2). <h3>Conclusion</h3> Parkinson’s disease-related mortality among U.S. adults with cardiometabolic comorbidities rose considerably from 1999–2020, especially in recent years, with higher risk in males, older adults, white individuals, and rural populations. Findings highlight the need for targeted, regionally tailored prevention strategies and integrated cardiovascular and neurologic care for high-risk populations.

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