{
  "abstract": "Introduction Rheumatic valvular disease (RVD) is a chronic consequence of acute rheumatic fever and remains a significant cause of cardiovascular morbidity and mortality worldwide. While largely reduced in industrialized nations, RVD persists among older adults, immigrants from endemic regions, and disadvantaged populations in the United States. Population-level trends in RVD mortality and demographic disparities remain incompletely characterized.Methods We analyzed mortality data from the CDC Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) for U.S. adults from 1999–2020. Deaths listing rheumatic mitral (I05.0–I05.9), aortic (I06.0–I06.9), or tricuspid (I07.0–I07.9) valve disease as underlying or contributing causes were included. Crude and age-adjusted mortality rates (AAMRs) per 100,000 populations were calculated and standardized to the 2000 U.S. population. Joinpoint regression estimated annual percent changes (APCs) with 95% confidence intervals (CIs), stratified by sex, age, race/ethnicity, urbanization, and state.Results From 1999–2020, U.S. age-adjusted mortality from rheumatic valvular disease declined from 1.8 (95% CI: 1.8–1.9) to 1.2 (95% CI: 1.2–1.3) between 1999–2004 (APC −7.21%, 95% CI −9.8 to −4.5), remained largely stable through 2015, and then increased to 1.4 (95% CI: 1.4–1.5) by 2020 (APC 2.56%, 95% CI 1.2–4.1). Women consistently had higher age-adjusted mortality than men across all years. Both sexes demonstrated late-period increases, with sharper rises from 2018–2020 among men (APC 16.34%, 95% CI 7.2–28.0) and women (APC 11.36%, 95% CI 7.8–15.0). Mortality increased steeply with age. Younger adults (35–44 years) had persistently low rates with a modest late-period rise (APC 3.94%, 95% CI 0.7–7.2), whereas older adults (≥65 years) bore the greatest burden. Adults aged ≥85 years had the highest crude mortality in 2020 (28.8 per 100,000) with a significant late-period increase (APC 7.65%, 95% CI 4.1–11.3). By 2020, age-adjusted mortality was highest among White and non-Hispanic populations (1.5 per 100,000), intermediate among Hispanic and Asian/Pacific Islander populations (1.0), and lowest among Black or African American individuals (0.5). States with age-adjusted mortality rates at or above the 90th percentile (≥2.0 per 100,000) included Minnesota (2.1), North Dakota (2.0), Oregon (2.0), Vermont (2.0), Washington (2.0) and Wyoming (2.0) ( figures 1 and 2).Conclusions RVD-related mortality in the U.S. experienced an initial decline followed by a late-period resurgence from 2015–2020. Disparities persist across sex, age, race, urbanization, and geography, highlighting ongoing public health challenges. These findings underscore the need for targeted prevention, timely diagnosis, and improved management strategies for vulnerable populations.Abstract 254 Figure 1Age adjusted rate for at rheumatic valvular disease stratified against gender in the U.S, 1999–2020Abstract 254 Figure 2Crude rate for rheumatic valvular disease stratified against age groups in the U.S, 1999–2020",
  "authors": [
    {
      "affiliations": [
        "University College of Medicine and Dentistry, Lahore, Pakistan"
      ],
      "name": "Suleman Saeed"
    },
    {
      "affiliations": [
        "University College of Medicine and Dentistry, Lahore, Pakistan"
      ],
      "name": "Hamid Bin Tariq"
    },
    {
      "affiliations": [
        "University College of Medicine and Dentistry, Lahore, Pakistan"
      ],
      "name": "Mesham Zainab"
    },
    {
      "affiliations": [
        "Foundation University Medical College, Islamabad, Pakistan"
      ],
      "name": "Muhammad Saad Iqbal"
    },
    {
      "affiliations": [
        "University College of Medicine and Dentistry, Lahore, Pakistan"
      ],
      "name": "Taha Shahbaz"
    },
    {
      "affiliations": [
        "University College of Medicine and Dentistry, Lahore, Pakistan"
      ],
      "name": "Aiman Aijaz"
    },
    {
      "affiliations": [
        "University College of Medicine and Dentistry, Lahore, Pakistan"
      ],
      "name": "Zoha Kashif"
    },
    {
      "affiliations": [
        "Foundation University Medical College, Islamabad, Pakistan"
      ],
      "name": "Haider Imran"
    },
    {
      "affiliations": [
        "Fatima Jinnah Medical University, Lahore, Pakistan"
      ],
      "name": "Tuba Shakoor"
    },
    {
      "affiliations": [
        "Khyber Medical University, Peshawar, Pakistan"
      ],
      "name": "Haseeb Sadaqat"
    },
    {
      "affiliations": [
        "Saidu Medical College, Sawat, Pakistan"
      ],
      "name": "Maria Sadaqat"
    },
    {
      "affiliations": [
        "Rawalpindi Medical College, Rawalpindi, Pakistan"
      ],
      "name": "Umair Mushtaq"
    }
  ],
  "title": "254 Trends and disparities in mortality from rheumatic valvular disease in the United States: a CDC analysis, 1999–2020",
  "uid": "b53aee07-2840-56a2-9fe8-264342cefe3a"
}