Trends in Tetralogy of Fallot-Related Mortality in the United States Between 1999 and 2020.

Abstract

We sought to identify mortality trends related to Tetralogy of Fallot (ToF) in the U.S. population, with specific emphasis on age-related, racial, and geographic differences. Death certificate data was retrieved from the CDC WONDER database, where crude mortality rate (CMR) and age-adjusted mortality rates (AAMR) with 95% CIs per 1,000,000 population were identified, along with annual percentage changes (APCs) and average annual percentage change (AAPC) determined by Joinpoint regression. From 1999 to 2020, a total of 5523 deaths were reported in association with ToF, with nearly half of all deaths occurring during the first year of life. The AAMR steadily decreased from 1999 to 2020 (AAPC: - 1.26, 95% CI - 2.29 to -0.38, p-value = 0.012). Males had a slightly higher AAMR (0.91) than females (0.77). Non-Hispanic (NH) Blacks/African Americans had a higher AAMR (1.00) compared with NH Whites (0.83). Infants less than a year old exhibited the highest CMRs among all age groups. Although lower rates were seen among all age strata < 45 years of age, deaths in patients > 45 years significantly increased from 2013 to 2020 (APC 6.17, 95% CI 0.79 to 20.35, p-value = 0.047). Rural areas consistently exhibited greater AAMRs and lesser declines over time compared to urban areas, with most deaths occurring in medical facilities. Over the last 2 decades in the US, the mortality rates associated with ToF have steadily decreased. Focusing resources on these higher risk populations may prove beneficial.