Trends and Projections in Valvular Heart Disease Mortality Among Older Adults in the United States, 1999-2040.

Valvular heart disease (VHD) contributes substantially to cardiovascular mortality. We evaluated long-term VHD mortality trends among older adults to inform healthcare planning. CDC WONDER mortality data (1999-2023) were analyzed for adults aged ≥65 years to calculate age-adjusted mortality rates (AAMRs). Joinpoint regression identified temporal trends, alongside a subtype analysis stratifying AAMRs by nonrheumatic aortic (ICD-10 I35), mitral (ICD-10 I34), tricuspid (ICD-10 I36), and chronic rheumatic (ICD-10 I05-I09) valve disorders. Age-period-cohort modeling assessed generational effects, and ARIMA models projected mortality rates through 2040. Among 1,204,490 VHD deaths, the AAMR declined from 1999 to 2018 (annual percent change [APC] -0.87) but significantly increased from 2018 to 2023 (APC 1.52). Nonrheumatic aortic valve disorders accounted for the vast majority of deaths, demonstrating a continuous decline (APC -0.20). Tricuspid valve disorders showed a sustained rise (APC 7.30), mitral valve disorders exhibited a biphasic pattern reversing after 2012, and chronic rheumatic diseases showed a post-2017 resurgence. Mortality was highest among non-Hispanic White individuals, men, nonmetropolitan residents, and in the West. Age-period-cohort analysis demonstrated generational divergence: recent cohorts experienced lower mortality at ages 65-69, whereas adults aged ≥85 years faced progressively higher risks. Forecasting models project the recent resurgence will transition into a sustained plateau, stabilizing at 109.2 deaths per 100,000 population through 2040. Ultimately, after two decades of decline, the VHD mortality trend reversed course and is projected to remain stably elevated. This disproportionate impact among the oldest-old and rural populations underscores the need for targeted strategies to mitigate widening disparities.