Mortality Trends in Heart Failure and Pneumonia Among US Adults Aged 65 and Older: Analysis of CDC WONDER Data.

BACKGROUND: Heart failure (HF) and pneumonia are leading causes of morbidity and mortality in older adults. Their coexistence poses major clinical challenges and complicates management. This study quantified and analyzed mortality trends where both HF and pneumonia were listed as multiple causes of death, with attention to disparities by sex, race/ethnicity, age, region, state, and urban-rural status. METHODS: We conducted a retrospective observational analysis using the CDC WONDER multiple-cause mortality database (1999-2020), including deaths in which both HF and pneumonia were recorded on death certificates. Age-adjusted mortality rates (AAMRs) per 100,000, with 95% confidence intervals (CIs), were calculated across demographic, geographic, and temporal variables using ICD-10 codes. Joinpoint regression identified statistically significant (p < 0.05) trend changes and annual percent changes (APCs). RESULTS: A total of 502,834 deaths occurred in adults ≥65 years with both HF and pneumonia. In men, AAMR declined from 109.4 in 1999 to 63.5 in 2020; in women, from 80.3 to 40.7. Non-Hispanic (NH) White adults had the highest racial AAMR (56.7). The Midwest reported the highest regional AAMR (100.4), while West Virginia ranked highest among states (88.0). Non-metropolitan areas showed a higher AAMR (72.9) compared with metropolitan areas. CONCLUSIONS: From 1999 to 2018, HF and pneumonia mortality rates declined but rose again in 2020, potentially reflecting pandemic-related impacts and increased vulnerability in this population. Persistent disparities were observed across sex, race/ethnicity, geography, and urban-rural status. These findings underscore the need for targeted public health strategies to reduce mortality and narrow disparities in older adults with HF and pneumonia.