{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T06:04:01Z","timestamp":1779775441953,"version":"3.53.1"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To examine national trends and disparities in cardiovascular mortality associated with systemic connective tissue disorders (CTDs) in the United States from 1999 to 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed mortality data from the CDC WONDER database. Deaths were included where CTD (ICD\u201010: M05, M06, M30\u2013M35) was the underlying cause and cardiovascular disease was a contributing cause. Age\u2010adjusted mortality rates (AAMRs) per 1\u2009000\u2009000 were calculated using the 2000 US Standard Population. Joinpoint regression identified annual and average annual percentage changes. Analyses were stratified by sex, race\/ethnicity, census region, and urbanization. Disease subgroup and state\u2010level analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between 1999 and 2020, 47\u2009752 cardiovascular deaths occurred among individuals with systemic CTDs. The national AAMR declined from 14.4 to 8.2 per 1\u2009000\u2009000 (AAPC: \u22122.68%, 95% CI: \u22122.89 to \u22122.47,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Females had consistently higher mortality than males (average AAMR: 13.5 vs. 5.9 per 1\u2009000\u2009000;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Non\u2010Hispanic Black individuals had the highest rates (average AAMR: 14.9 per 1\u2009000\u2009000), with widening disparities after 2008. Rural areas had higher mortality than urban areas (average AAMR: 11.4 vs. 9.9 per 1\u2009000\u2009000;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). Subgroup analyses revealed heterogeneous trends across CTD subtypes, with SLE showing the slowest improvement (AAPC: \u22121.87%) and dermatomyositis the steepest decline (AAPC: \u22124.98%). State\u2010level AAMRs ranged 2.2\u2010fold, from 6.3 (District of Columbia) to 13.6 (Montana) per 1\u2009000\u2009000.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cardiovascular mortality associated with systemic CTDs has declined significantly over two decades; however, persistent racial disparities, urban\u2013rural differences, heterogeneous disease\u2010specific trends, and substantial geographic variation underscore the need for targeted, equitable interventions in this high\u2010risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1756-185x.70681","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:38:26Z","timestamp":1777984706000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Cardiovascular Mortality Associated With Systemic Connective Tissue Disorders in the United States: A 22\u2010Year Population\u2010Based National Analysis (1999\u20132020)"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3096-8824","authenticated-orcid":false,"given":"Chukwuemeka Christian","family":"Aghasili","sequence":"first","affiliation":[{"name":"Geisinger Wyoming Valley Medical Center  Wilkes\u2010Barre Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1204-2731","authenticated-orcid":false,"given":"Reuben Laryea","family":"Odai","sequence":"additional","affiliation":[{"name":"University of Kansas School of Medicine \u2013  Wichita Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6963-9221","authenticated-orcid":false,"given":"Samuel A.","family":"Mensah","sequence":"additional","affiliation":[{"name":"West Virginia University School of Medicine  Morgantown West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8768-7993","authenticated-orcid":false,"given":"Manfred","family":"Mate\u2010Kole","sequence":"additional","affiliation":[{"name":"Beth Israel Deaconess Medical Center General Medicine Division  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7601-8501","authenticated-orcid":false,"given":"Nathaniel","family":"Eyiah","sequence":"additional","affiliation":[{"name":"Ho Teaching Hospital  Ho Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2148-1923","authenticated-orcid":false,"given":"Timothy","family":"Kopah","sequence":"additional","affiliation":[{"name":"Manna Mission Hospital  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0459-2005","authenticated-orcid":false,"given":"Albert","family":"Orhin","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9298-7888","authenticated-orcid":false,"given":"Isaac Adjei","family":"Opoku","sequence":"additional","affiliation":[{"name":"Bridgeport Hospital, Yale New Haven Health  Bridgeport Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9465-0089","authenticated-orcid":false,"given":"Ikponmwosa Jude","family":"Ogieuhi","sequence":"additional","affiliation":[{"name":"Northwestern Medicine McHenry Hospital  McHenry Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4945-1004","authenticated-orcid":false,"given":"Gregory I.","family":"Atafo","sequence":"additional","affiliation":[{"name":"The Bank Hospital  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9303-0978","authenticated-orcid":false,"given":"Martin E.","family":"Matsumura","sequence":"additional","affiliation":[{"name":"Geisinger Wyoming Valley Medical Center  Wilkes\u2010Barre Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1148\/RG.2019180078"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/1744666X.2017.1327352"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ART.38239"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JACC.2021.02.029\/SUPPL_FILE\/MMC1.DOCX"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3899\/JRHEUM.130874"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/OXFORDJOURNALS.AJE.A009122"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.SEMARTHRIT.2012.12.002"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/RHEUMATOLOGY\/KEP252"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ART.24092"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/RHEUMATOLOGY\/KET411"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JAUT.2022.102863"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/S00281\u2010022\u201000922\u2010Y"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/JOIM.13557"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005792\u2010199209000\u201000004"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/FIMMU.2022.974826\/XML"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/DIAGNOSTICS13111870"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.3899\/JRHEUM.220279"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ART.23177"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PGPH.0004705"},{"key":"e_1_2_11_21_1","unstructured":"CDC Wonder \u201cCDC \u201d(2025) https:\/\/wonder.cdc.gov\/."},{"key":"e_1_2_11_22_1","first-page":"1","article-title":"2013 NCHS Urban\u2010Rural Classification Scheme for Counties","volume":"166","author":"Ingram D. D.","year":"2014","journal-title":"Vital Health Stat 2"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1097\u20100258(20000215)19:3<335::aid\u2010sim336>3.0.co;2\u2010z"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/SIM.3733"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/ACR.22783\/ABSTRACT"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/ART.34359"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/ANNRHEUMDIS\u20102017\u2010211663"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/ANNRHEUMDIS\u20102018\u2010214802"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/EURJPC\/ZWAD278"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/ART.21976"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/HEARTJNL\u20102024\u2010324625"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1191\/0961203306LU2305XX"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/ART.37795"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000782"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067\u2010022\u201006268\u2010y"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13957"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr2.70057"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.04.054"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23518"}],"container-title":["International Journal of Rheumatic Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1756-185x.70681","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1756-185x.70681","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1756-185x.70681","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T05:32:08Z","timestamp":1779773528000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1756-185x.70681"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/1756-185x.70681"],"URL":"https:\/\/doi.org\/10.1111\/1756-185x.70681","archive":["Portico"],"relation":{},"ISSN":["1756-1841","1756-185X"],"issn-type":[{"value":"1756-1841","type":"print"},{"value":"1756-185X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2025-11-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70681"}}