Temporal Trends and Demographic Disparities in Mortality from Heart Failure with Co-Existing Iron Deficiency Anemia in the United States, 1999-2020

Introduction Heart failure (HF) is a rapidly prevalent issue and affects individuals across diverse demographics. Various comorbidities can exacerbate HF symptoms in certain populations and may predict poorer outcomes. The aim of this study was to conduct a retrospective analysis of mortality trends stratified by gender, race, geographic distribution, and urbanization in HF patients with iron deficiency anemia (IDA). Methods The CDC WONDER multiple causes of death database was used for analysis of HF with IDA-related mortality in adults (≥25 years of age) from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 population were computed using ICD-10 codes I50 (HF) and D50 (IDA). Joinpoint regression was used to visualize the mortality trends and calculate the average annual percentage change (AAPC) and annual percentage change (APC). Results Between 1999 and 2020, HF with IDA caused 7226 deaths in the US adult population. The mortality rate showed an initial decline (1999-2012), but later (2012-2020) a significant up-rising trend was appreciated in the AAMR, with an APC of -2.4% (95% CI: -3.6–1.3, p<0.001) to 13% (95% CI: 11.2-15.5, p<0.001). Males exhibited a consistently higher AAMR with an AAPC of 3.6% (95% CI: 2.6-4.7, p<0.001) against 3.1% (95% CI: 2.4-3.9, p<0.001) in females. The analysis also indicates that the white population has the highest mortality among all races, with an AAMR of 0.16 (95% CI: 0.15-0.16), followed by 0.14 (95% CI: 0.09-0.2) in the American Indian/Alaska Native population. Census records from all the regions showed upward trending, with the West and Northeast regions displaying AAPC values of 3.95% (95% CI: 2.6-5.6, p<0.001) and 3.5% (95% CI: 2.2-5.2, p<0.001), respectively. Stratification based on urbanization displayed a significantly higher mortality trend among the rural population when compared with the urban population. Conclusion A significant upsurge has been observed in the mortality trends of HF with IDA in recent years. When stratified by gender, race, census region, and rural/urban area, disparities in mortality rates were observed. This highlights the need to identify vulnerable populations, determine modifiable and non-modifiable variables, and implement proactive healthcare policies aimed at reducing the rising mortality burden among HF patients with IDA.