CLINICAL RESEARCH
Trends in pediatric sudden cardiac death-related mortality in the United States from 1999 to 2020: a nationwide CDC WONDER analysis
1
Sheikh Khalifa Medical City, Abu Dhabi, UAE
2
NMC Royal Hospital, Abu Dhabi, UAE
3
Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
4
David Tvildiani Medical University, Tbilisi, Georgia
5
University of Latvia, Latvia
6
Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India
7
King Hamad University Hospital, Royal Medical Services, Muharraq, Bahrain
Submission date: 2025-12-03
Final revision date: 2026-05-05
Acceptance date: 2026-08-05
Publication date: 2026-09-28
Arch Med Sci Atheroscler Dis 2026;11(1):190-197
KEYWORDS
sociodemographic disparitiespediatric mortalityUnited States population healthepidemiologystate-level disparities
TOPICS
ABSTRACT
Introduction:
Sudden cardiac death (SCD) in children is rare but devastating, often affecting previously healthy children. Unlike adults, pediatric SCD results from a wide spectrum of uncommon and heterogeneous conditions. Despite recent advancements in understanding and prevention strategies, national data on long-term mortality trends remain limited.
Material and methods:
We analyzed death certificate data from the CDC WONDER database from 1999 to 2020 for SCD-related mortality in individuals aged 0 to 14 years. Age-adjusted mortality rates (AAMRs) per 100,000, with 95% confidence intervals (CIs) and annual percentage changes (APCs) with 95% CIs, were calculated, stratified by year, sex, race, state, urbanization, and census region.
Results:
From 1999 until 2020, 30,675 pediatric SCD-related deaths occurred. The AAMR declined from 2.8 per 100,000 population in 1999 to 2.5 (APC = –6.0%, 95% CI: –10.8 to –0.9) in 2001 and further to 2.0 in 2020 (APC = –1.0%, 95% CI: –1.2 to –0.8). AAMRs were consistently higher in males than in females (1999: 3.2 vs. 2.4; 2020: 2.1 vs. 2.0). When stratified by race, non-Hispanic (NH) Black children had the highest AAMRs. Rates declined in all U.S. regions, with the highest rates observed in the Northeast (3.5 to 1.9) and the lowest in the Midwest (1.7 to 1.2). State-level rate disparities were marked, ranging from 4.9 in Mississippi to as low as 1.1 in Maine, Maryland, and Wisconsin.
Conclusions:
Despite overall declines in SCD-related mortality, significant disparities persist across sex, race, region, and urbanization.
Sudden cardiac death (SCD) in children is rare but devastating, often affecting previously healthy children. Unlike adults, pediatric SCD results from a wide spectrum of uncommon and heterogeneous conditions. Despite recent advancements in understanding and prevention strategies, national data on long-term mortality trends remain limited.
Material and methods:
We analyzed death certificate data from the CDC WONDER database from 1999 to 2020 for SCD-related mortality in individuals aged 0 to 14 years. Age-adjusted mortality rates (AAMRs) per 100,000, with 95% confidence intervals (CIs) and annual percentage changes (APCs) with 95% CIs, were calculated, stratified by year, sex, race, state, urbanization, and census region.
Results:
From 1999 until 2020, 30,675 pediatric SCD-related deaths occurred. The AAMR declined from 2.8 per 100,000 population in 1999 to 2.5 (APC = –6.0%, 95% CI: –10.8 to –0.9) in 2001 and further to 2.0 in 2020 (APC = –1.0%, 95% CI: –1.2 to –0.8). AAMRs were consistently higher in males than in females (1999: 3.2 vs. 2.4; 2020: 2.1 vs. 2.0). When stratified by race, non-Hispanic (NH) Black children had the highest AAMRs. Rates declined in all U.S. regions, with the highest rates observed in the Northeast (3.5 to 1.9) and the lowest in the Midwest (1.7 to 1.2). State-level rate disparities were marked, ranging from 4.9 in Mississippi to as low as 1.1 in Maine, Maryland, and Wisconsin.
Conclusions:
Despite overall declines in SCD-related mortality, significant disparities persist across sex, race, region, and urbanization.
REFERENCES (28)
1.
Kumar A, Avishay DM, Jones CR, et al. Sudden cardiac death: epidemiology, pathogenesis and management. Rev Cardiovasc Med 2021; 22: 147-58.
2.
Zuin M, Mohanty S, Aggarwal R, et al. Trends in sudden cardiac death among adults aged 25 to 44 years in the united states: an analysis of 2 Large US Databases. J Am Heart Assoc 2025; 14: e035722.
3.
El-Assaad I, Al-Kindi SG, Aziz PF. Trends of out-of-hospital sudden cardiac death among children and young adults. Pediatrics 2017; 140: e20171438.
4.
Chugh SS, Reinier K, Balaji S, et al. Population-based analysis of sudden death in children: the Oregon Sudden Unexpected Death Study. Heart Rhythm 2009; 6: 1618-22.
5.
Schwartz PJ, Ackerman MJ, Antzelevitch C, et al. Inherited cardiac arrhythmias. Nat Rev Dis Primers 2020; 6: 58.
6.
Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009; 119: 1085-92.
7.
Bagnall RD, Weintraub RG, Ingles J, et al. A prospective study of sudden cardiac death among children and young adults. N Engl J Med 2016; 374: 2441-52.
8.
Lynge TH, Albert CM, Basso C, et al. Autopsy of all young sudden death cases is important to increase survival in family members left behind. Europace 2024; 26: euae128.
9.
Gathers CL, Rossano JW, Griffis H, et al. Sociodemographic disparities in incidence and survival for pediatric out-of-hospital cardiac arrest in the United States. Resuscitation 2025; 211: 110607.
10.
Winkel BG, Risgaard B, Bjune T, et al. Gender differences in sudden cardiac death in the young-a nationwide study. BMC Cardiovasc Disord 2017; 17: 19.
11.
Centers for Disease Control and Prevention. CDC WONDER (2021). https://wonder.cdc.gov/. Accessed: August 10, 2025.
12.
Bhagwan R, Nabi R, Rath S, et al. Trends in sudden cardiac death related mortality in adults in the United States: a CDC WONDER Database Analysis, 1999-2020. Clin Cardiol 2025; 48: e70180.
13.
von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 2014; 12: 1495-9.
14.
Aggarwal R, Chiu N, Loccoh EC, Kazi DS, Yeh RW, Wadhera RK. Rural-urban disparities: diabetes, hypertension, heart disease, and stroke mortality among black and white adults, 1999-2018. J Am Coll Cardiol 2021; 77: 1480-1.
15.
Ingram DD, Franco SJ. 2013 NCHS urban-rural classification scheme for counties. Vital Health Stat 2 2014; 166: 1-73.
16.
Joinpoint Regression Program, Version 5.4.0.0 - April 2025; Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute. https://surveillance.cancer.go.... Accessed: July 20, 2025.
17.
Winkel BG, Holst AG, Theilade J, et al. Nationwide study of sudden cardiac death in persons aged 1-35 years. Eur Heart J 2011; 32: 983-90.
18.
Winkel BG, Risgaard B, Sadjadieh G, Bundgaard H, Haunsø S, Tfelt-Hansen J. Sudden cardiac death in children (1-18 years): symptoms and causes of death in a nationwide setting. Eur Heart J 2014; 35: 868-75.
19.
Pilmer CM, Kirsh JA, Hildebrandt D, Krahn AD, Gow RM. Sudden cardiac death in children and adolescents between 1 and 19 years of age. Heart Rhythm 2014; 11: 239-45.
20.
Kanter RJ, Pfeiffer R, Hu D, Barajas-Martinez H, Carboni MP, Antzelevitch C. Brugada-like syndrome in infancy presenting with rapid ventricular tachycardia and intraventricular conduction delay. Circulation 2012; 125: 14-22.
21.
Tester DJ, Medeiros-Domingo A, Will ML, Haglund CM, Ackerman MJ. Cardiac channel molecular autopsy: insights from 173 consecutive cases of autopsy-negative sudden unexplained death referred for postmortem genetic testing. Mayo Clin Proc 2012; 87: 524-39.
22.
Unger B, Kemp JS, Wilkins D, et al. Racial disparity and modifiable risk factors among infants dying suddenly and unexpectedly. Pediatrics 2003; 111: E127-31.
23.
Duncan JR, Byard RW, eds. SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future. Adelaide (AU): University of Adelaide Press 2018.
24.
Examining the racial and ethnic diversity of adults and children. The United States Census Bureau. (2023). https://www.census.gov/newsroo.... Accessed: August 10, 2025.
25.
Zabell J, Nashelsky M, Thomsen T, Alpen MA, Kealey GP, Light TD. Rural versus urban trauma: demographic influences on autopsy rates. J Surg Res 2009; 155: 132-5.
26.
Winkel BG, Holst AG, Theilade J, et al. Differences in investigations of sudden unexpected deaths in young people in a nationwide setting. Int J Legal Med 2012; 126: 223-9.
27.
Filippatos G, Andriopoulos P, Panoutsopoulos G, et al. The quality of death certification practice in Greece. Hippokratia 2016; 20: 19-25.
28.
Hazard RH, Chowdhury HR, Adair T, et al. The quality of medical death certification of cause of death in hospitals in rural Bangladesh: impact of introducing the International Form of Medical Certificate of Cause of Death. BMC Health Serv Res 2017; 17: 688.
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