Trends and Disparities in Acute Myocardial Infarction‐Related Mortality With Co‐Listed Nicotine Dependence in the United States, 1999–2020

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BACKGROUND: Nicotine use is a major modifiable risk factor for acute myocardial infarction (AMI), yet national mortality patterns involving co-listed nicotine dependence remain under-characterized. METHODS: Using CDC WONDER Multiple Cause of Death data from 1999 to 2020, we evaluated AMI-related mortality among US adults aged ≥ 25 years with co-listed death-certificate-coded nicotine dependence, operationally defined using ICD-10 F17.0-F17.9. AMI was identified using ICD-10 I21.0-I22.9. Age-adjusted mortality rates (AAMRs) per 100 000 population were calculated using the 2000 US standard population. Temporal trends were assessed using Joinpoint regression and stratified by sex, age, race/ethnicity, region, urbanization, state, and place of death. RESULTS: From 1999 to 2020, 357 167 AMI-related deaths with co-listed nicotine dependence occurred among adults aged ≥ 25 years. The AAMR increased from 1.64 to 9.46 per 100 000 population (average annual percent change, 10.27%; p < 0.001). Men had higher AAMRs than women (11.30 vs. 4.27), with significant increases in both groups. Mortality increased with age, highest among adults aged ≥ 85 years (33.55) and lowest among those aged 35-44 years (0.83). Non-Hispanic American Indian/Alaska Native adults had the highest AAMR (10.30). Rates were higher in the Midwest and South, nonmetropolitan areas exceeded metropolitan areas, and the highest state-level AAMRs occurred in North Dakota and Wyoming. Most deaths occurred in inpatient facilities or at home. CONCLUSION: AMI-related mortality with co-listed nicotine dependence increased substantially from 1999 to 2020, with persistent demographic and geographic disparities. These findings may inform targeted tobacco-control, nicotine-cessation, and cardiovascular prevention strategies for high-risk populations over time.