Trends in Heart Failure–Related Mortality in San Francisco County, California, From 1999 to 2020

Heart failure (HF) is a leading contributor to mortality in the United States, with notable disparities by geography, race/ethnicity, and age. This study examined long-term trends and demographic patterns in HF-related mortality in San Francisco County over a 22-year period.

We analyzed adult mortality data (ages ≥25 years) from the CDC WONDER Multiple Cause of Death database. HF-related deaths were identified using ICD-10 code I50. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Joinpoint regression was used to assess trends and estimate annual percent change (APC) with 95% confidence intervals. Results were stratified by sex, race/ethnicity, age group and place of death.

A total of 14,099 HF-related deaths occurred in San Francisco between 1999 and 2020. The overall AAMR was 180.52 per 100,000 population, declining from 240.47 in 1999 to 154.45 in 2020, with a significant decrease from 1999-2011 [APC: –3.13 (95% CI: –3.85 to –2.40)]. Mortality was higher among males (217.57) than females (153.19). Non-Hispanic Black individuals had the highest AAMR (321.06), followed by non-Hispanic White (214.51), Hispanic/Latino (157.05), and non-Hispanic Asian or Pacific Islander (124.83). Mortality increased markedly with age: 459.99 in older adults vs. 21.48 in middle-aged adults. Most deaths occurred in institutional settings: 43.75% in inpatient facilities, 27.75% at home, and 18.54% in long-term care.

Heart failure mortality in San Francisco declined significantly over the study period, reflecting national improvements in cardiovascular care. However, disparities persist across sex, age, and race/ethnicity. Most deaths occurred in institutional settings, underscoring the need for expanded access to community-based care and end of life support. Continued equity-focused strategies are essential to reduce the burden of HF mortality.