Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019

Sourbha S. Dani, Ahmad N. Lone, Zulqarnain Javed, Muhammad S. Khan, Muhammad Zia Khan, Edo Kaluski, Salim S. Virani, Michael D. Shapiro, Miguel Cainzos-Achirica, Khurram Nasir, Safi U. Khan

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


BACKGROUND: Evaluating premature (<65 years of age) mortality because of acute myocardial infarction (AMI) by demographic and regional characteristics may inform public health interventions. METHODS AND RESULTS: We used the Centers for Disease Control and Prevention’s WONDER (Wide-Ranging Online Data for Epidemiologic Research) death certificate database to examine premature (<65 years of age) age-adjusted AMI mortality rates per 100 000 and average annual percentage change from 1999 to 2019. Overall, the age-adjusted AMI mortality rate was 13.4 (95% CI, 13.3–13.5). Middle-aged adults, men, non-Hispanic Black adults, and rural counties had higher mortality than young adults, women, NH White adults, and urban counties, respectively. Between 1999 and 2019, the age-adjusted AMI mortality rate decreased at an average annual percentage change of −3.4 per year (95% CI, −3.6 to −3.3), with the average annual percentage change showing higher decline in age-adjusted AMI mortality rates among large (−4.2 per year [95% CI, −4.4 to −4.0]), and me-dium/small metros (−3.3 per year [95% CI, −3.5 to −3.1]) than rural counties (−2.4 per year [95% CI, −2.8 to −1.9]). Age-adjusted AMI mortality rates >90th percentile were distributed in the Southern states, and those with mortality <10th percentile were clustered in the Western and Northeastern states. After an initial decline between 1999 and 2011 (−4.3 per year [95% CI, −4.6 to −4.1]), the average annual percentage change showed deceleration in mortality since 2011 (−2.1 per year [95% CI, −2.4 to −1.8]). These trends were consistent across both sexes, all ethnicities and races, and urban/rural counties. CONCLUSIONS: During the past 20 years, decline in premature AMI mortality has slowed down in the United States since 2011, with considerable heterogeneity across demographic groups, states, and urbanicity. Systemic efforts are mandated to ad-dress cardiovascular health disparities and outcomes among nonelderly adults.

Original languageEnglish (US)
Article numbere021682
Pages (from-to)e021682
JournalJournal of the American Heart Association
Issue number1
StatePublished - Jan 4 2022


  • Acute myocardial infarction
  • Epidemiology
  • Mortality
  • Humans
  • Middle Aged
  • Male
  • Young Adult
  • Mortality, Premature
  • Ethnicity
  • Myocardial Infarction
  • United States/epidemiology
  • Rural Population
  • Female
  • Racial Groups

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019'. Together they form a unique fingerprint.

Cite this