B58-23 National Trends in Smoking-associated Pulmonary Hypertension Mortality in the United States, 1999-2020

Rationale

Smoking-related lung disease is traditionally framed as airway injury; however, tobaccoexposure also promotes pulmonary vascular remodeling and right ventricular (RV) failure.Pulmonary hypertension (PH) associated with smoking-related lung disease remains poorlycharacterized at the population level. We examined national mortality trends to determinewhether PH deaths with documented smoking exposure are increasing over time.

Methods

Using CDC WONDER mortality data from 1999-2020, we identified deaths with pulmonaryhypertension listed as the underlying cause (ICD-10 I27). Smoking exposure was assessedusing nicotine dependence recorded as a multiple cause of death (F17). Age-adjusted mortalityrates, annual deaths, and sex-stratified trends were calculated for PH overall and for the subsetof PH deaths listing nicotine dependence. Temporal trends were evaluated using Poisson ornegative binomial regression models with population offsets to estimate annual percent change(APC) and 95% confidence intervals (CI). Segmented regression was performed as a sensitivityanalysis. Years with unstable estimates were excluded from model fitting per CDC guidance.

Results

Age-adjusted PH mortality increased steadily in both females and males over the study period.Among PH deaths, those listing nicotine dependence demonstrated steeper increases inmortality rates than PH overall. The proportion of PH deaths with documented nicotinedependence increased from approximately 3% to 10% among females and from 3% to 15-17%among males. Trend models showed statistically significant APCs for PH overall, with largerAPCs observed in the nicotine-associated PH subset.

Conclusions

Pulmonary hypertension mortality in the United States has increased over the past twodecades, with a growing proportion of deaths occurring among individuals with documentedsmoking exposure. These findings highlight an expanding burden of smoking-associatedpulmonary vascular and RV disease, extending the impact of tobacco exposure beyond airway-centered outcomes.

This abstract is funded by: None