Age-adjusted mortality rates for US adults aged ≥65 years with both COPD and cardiac arrest listed on death certificates declined from 86.4 in 1999 to 52.5 in 2023, but remained heterogeneous across demographic and geographic strata.
Key Findings
Results
Overall age-adjusted mortality rates (AAMRs) for deaths involving concurrent coding of COPD and cardiac arrest declined substantially over the 25-year study period.
A total of 718,280 deaths were identified with both COPD (ICD-10 J41-J44) and cardiac arrest (I46) listed on death certificates among US adults aged ≥65 years from 1999 to 2023.
AAMRs declined from 86.4 in 1999 to 52.5 in 2023.
A significant decrease occurred from 1999 to 2006 (APC: -2.87; P = .01), followed by a plateau period.
A further significant decline occurred from 2021 to 2023 (APC: -4.77; P < .001).
Data were sourced from CDC WONDER Multiple Cause of Death database.
Results
Older men had substantially higher AAMRs than older women for deaths involving both COPD and cardiac arrest.
Age-adjusted mortality rate for older men was 86.8 compared to 55.2 for older women.
This represents a difference of 31.6 per 100,000 between sexes.
Both sexes were drawn from the same population of US adults aged ≥65 years over the 1999–2023 study period.
Results
Non-Hispanic White individuals had the highest AAMRs among racial/ethnic groups, followed by NH Black/African American and Hispanic/Latino populations.
NH White individuals had an AAMR of 69.7.
NH Black/African American individuals had an AAMR of 64.3.
Hispanic/Latino individuals had an AAMR of 60.7.
Mortality rates were stratified by race/ethnicity across the full 1999–2023 study period.
Results
The West region of the United States reported the highest AAMR among all geographic regions.
The West region had an AAMR of 98.9, the highest of all US regions examined.
AAMRs were stratified by region across the full 1999–2023 study period.
Regional differences in mortality indicate geographic heterogeneity in concurrent COPD and cardiac arrest death certificate coding.
Results
Nonmetropolitan residents had higher AAMRs than metropolitan residents for deaths involving both COPD and cardiac arrest.
Nonmetropolitan residents had an AAMR of 70.8 compared to 67.9 for metropolitan residents.
The urbanization analysis was limited to 1999 to 2020 because urbanization classification data were not available after 2020.
This urban-rural disparity reflects geographic heterogeneity in mortality patterns across the study period.
Methods
The study used a retrospective cross-sectional design using multiple cause of death data and employed joinpoint regression to analyze temporal trends.
Data were obtained from CDC WONDER Multiple Cause of Death database for 1999–2023.
Deaths were identified using ICD-10 codes J41–J44 for COPD and I46 for cardiac arrest as either underlying or contributing causes.
Trends were analyzed using annual percentage changes (APCs) with 95% confidence intervals; P < .05 was considered statistically significant.
AAMRs were stratified by sex, race/ethnicity, region, and urbanization.
The authors explicitly noted that findings 'describe concurrent coding on death certificates and do not establish that COPD increases the risk of cardiac arrest or causes the observed deaths.'
What This Means
This research examined 25 years of US death certificate data (1999–2023) for older adults (age 65 and above) whose death certificates listed both chronic obstructive pulmonary disease (COPD) and cardiac arrest. Researchers found 718,280 such deaths over this period, and the overall death rate declined significantly — from 86.4 per 100,000 in 1999 to 52.5 per 100,000 in 2023. The decline was not steady: there was a notable drop from 1999 to 2006, a leveling off for many years, and then another decline from 2021 to 2023.
Despite the overall improvement, the data revealed important disparities. Men had much higher death rates than women (86.8 vs. 55.2 per 100,000). Non-Hispanic White individuals had the highest rates among racial/ethnic groups. People living in the western United States had the highest rates regionally, and those living in rural (nonmetropolitan) areas had higher rates than those in urban areas. These differences suggest that not all groups benefited equally from whatever factors drove the overall decline.
This research suggests that while national trends in deaths involving both COPD and cardiac arrest have improved over time, significant gaps remain across sex, race/ethnicity, geography, and urban-rural status. It is important to note that this study only describes how frequently both conditions appear together on death certificates — it does not prove that COPD causes cardiac arrest or that one condition directly led to death. These findings may help public health officials and researchers identify populations that could benefit from more targeted prevention or care efforts.
Khan S, Mayo J, Mohammed D, Aamer M, Goyal P, Ahmad M, et al.. (2026). Deaths involving chronic obstructive pulmonary disease and cardiac arrest in older US adults, 1999-2023: A retrospective cross-sectional study.. Medicine. https://doi.org/10.1097/MD.0000000000051160