Widening Racial and Sociodemographic Disparities in Cardiovascular Disease Death Counts in the United States: A Comprehensive Analysis of 2018-2023 National Data.

Introduction Cardiovascular disease (CVD) remains the leading cause of death in the United States, yet recent trends suggest widening disparities across race, sex, geography, and socioeconomic groups. Methods We conducted a retrospective, population-based trend analysis of mortality data from the National Vital Statistics System (NVSS), 2018-2023, accessed via the Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER) online Database. Deaths with CVD (International Classification of Diseases, 10th revision (ICD-10): I00-I99) as the underlying cause were included. Mortality counts were stratified by race (15 single-race categories), sex, age, census region, 2013 urbanization level, Hispanic origin, and education. Cause-specific analyses covered major ICD-coded CVD subcategories. Annualized percentage change (APC) and 95% confidence intervals (CI) were estimated using log-linear regression of annual counts. Results Between 2018 and 2023, there were 5.4 million CVD deaths nationwide, rising from 868,662 in 2018 to 915,973 in 2023. The steepest increases occurred in Pacific Islander (6.7%/year), Vietnamese (6.2%), and Asian Indian (6.1%) populations, while Whites individuals (1.2%) and Japanese (0.3%) showed minimal changes. By cause, ischemic and hypertensive heart diseases accounted for the largest gains. Regional increases were most pronounced in the South and West, and rural non-core areas exhibited the fastest growth. Younger adults (25-44 years) in Black individuals, Asian Indian, and American Indian groups showed APCs exceeding 5%. Women generally experienced higher APCs than men. Disparities were amplified by Hispanic origin and lower educational attainment. Conclusions CVD mortality in the United States is once again rising, with young adults, women, minority populations, rural residents, Hispanics, and the less educated experiencing the sharpest increases. These findings reveal a reversal of prior gains and underscore the urgent need for equity-focused prevention and policy strategies.