Temporal Trends and Demographic Disparities in Abdominal Aortic Aneurysm Mortality Among U.S. Adults Aged ≥ 65 Years, 1999–2024: A Nationwide Population-Based Analysis of CDC WONDER Data

Background: Abdominal aortic aneurysm (AAA) remains an important cause of cardiovascular mortality in the United States despite advances in screening, surveillance, and aneurysm repair. Contemporary national analyses evaluating long-term AAA mortality trends across demographic and geographic subgroups remain limited, particularly following the COVID-19 pandemic period. Objective: To evaluate temporal trends in AAA-related mortality among U.S. adults aged ≥ 65 years from 1999 to 2024 and characterize demographic and geographic disparities. Methods: A retrospective population-based study was conducted using the CDC WONDER Multiple Cause of Death database. AAA-related deaths were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes I71.3 and I71.4. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Mortality trends were stratified by sex, age, race/ethnicity, census region, and urbanization status. Joinpoint regression analysis was used to estimate annual percent change (APC) and average annual percent change (AAPC). Results: Between 1999 and 2024, a total of 208,476 AAA-related deaths among U.S. adults aged ≥ 65 years were recorded. Overall AAMR declined significantly from 32.61 per 100,000 population in 1999 to 12.17 per 100,000 population in 2024 (AAPC −3.86%; 95% confidence interval [CI]: −4.43 to −3.30; p < 0.001). Mortality rates remained consistently higher among males, adults aged ≥ 85 years, non-Hispanic White individuals, residents of the Midwest, and non-metropolitan populations. Joinpoint analysis demonstrated sustained declines across most demographic groups. Although several subgroups exhibited a temporary plateau in declining mortality trends during the pandemic era, these trend changes did not reach statistical significance. Following 2021, mortality rates resumed a significant downward trend. Conclusions: AAA-related mortality among U.S. adults aged ≥ 65 years declined substantially between 1999 and 2024; however, important demographic and geographic disparities persist. Continued efforts aimed at risk factor reduction, equitable screening access, and preventive vascular care remain essential to further reduce AAA-related mortality among older adults.