gms | German Medical Science

Background: While improvements in prevention and therapy have been linked to substantial decreases in CVD mortality during the past decades, recent analyses indicated an excess in deaths from acute myocardial infarction (AMI) during the pandemic year 2021 in Germany.

Objective: We aimed to further investigate most recent changes in long-term mortality trends for coronary heart disease (CHD) until the year 2022 with a focus on differential developments within sex- and age-specific strata.

Methods: For the population aged 25–84 years, we calculated age-standardised CHD mortality rates using mortality data of the German Federal Statistical Office for the period 1998–2022. CHD was defined based on the ICD-10 codes I20-25 and all analyses were carried out separately among women and men. The analyses were further stratified by age groups and ICD-10 subgroups I21-22 (AMI) and I25 (chronic CHD). We estimated annual percentage change (APC) and average annual percentage change (AAPC) with 95% confidence intervals using joinpoint regression models.

Results: Over the entire observation period 1998–2022, CHD mortality rates fell more strongly among women (AAPC: -4.9% [-5.2/-4.7]) than among men (AAPC: -3.8% [-4.0/-3.7]). However, downward trends in CHD mortality flattened during the past decade from -6.1% between 1998 and 2011 to -4.4% between 2011 and 2020 among women and from -5.2% between 1998 and 2010 to -3.1% between 2010 and 2019 among men. Since then, there was no significant change in trend development observed until the year 2022. In age-specific analyses, the decline in CHD mortality particularly slowed down during the past decade among age groups 60–74 years while mortality trends appeared to stagnate among older women and men aged 75–84 years during the years 2020–2022. In subgroup analyses, differences in overall mortality trends between women and men were more pronounced for chronic CHD than for AMI as we observed an AAPC of -5.1% for chronic CHD among women vs. -3.2% among men compared to an AAPC of -5.0% for AMI among women vs. -4.6% among men. The pre-pandemic decline in AMI mortality came to a halt among women after 2019 and even slightly increased among men. However, no such levelling off was observed for chronic CHD during the pandemic years.

Implication for research and/or (healthcare) practice: Our analyses pinpoint differences in recent changes in CHD mortality trends among women and men in Germany. The underlying factors that lead to diverging trends in CHD mortality across sex and age groups will be further investigated. Data on multiple cause of death statistics need to be explored in order to gain a deeper insight into mortality impact of public health crises such as the COVID-19 pandemic.