Aneurysmal degenerations of the thoracic aorta, known as thoracic aortic aneurysms, significantly contribute to the global mortality burden. Despite progress in medical care, disparities in thoracic aortic aneurysm-related mortality rates continue to affect various demographic and regional groups in the USA.

To investigate trends and disparities in thoracic aortic aneurysm-related mortality rates among adults in the USA from 1999 to 2020, with a focused analysis across demographic (sex, ethnicity and age group), temporal and geographical (census region, urbanization and state) domains.

We analysed death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database (1999–2020), with a focus on individuals aged≥25years. Age-adjusted mortality rates per 100,000 and annual percent changes, along with 95% confidence intervals, were calculated using joinpoint regression analysis.

From 1999 to 2020, a total of 47,136 thoracic aortic aneurysm-related deaths occurred in the USA, with an overall age-adjusted mortality rate of 1.01 per 100,000 individuals. Age-adjusted mortality rate trends revealed a significant decline from 1999 to 2012 (annual percent change −5.31), followed by stabilization from 2012 to 2020 (annual percent change −0.15). Disparities were observed across sex, ethnicity and census regions, with males, non-Hispanic Blacks and individuals residing in the Midwest showing higher age-adjusted mortality rates. Rural areas exhibited slightly higher age-adjusted mortality rates than urban areas, although both showed a decline over time.

This study underscores the persistent burden of thoracic aortic aneurysm-related deaths in the USA, revealing notable disparities in mortality rates across various demographic groups and regions. The results highlight the critical need for targeted public health interventions to address these disparities, and to improve thoracic aortic aneurysm-related outcomes for all population segments.