Vital signs: avoidable deaths from heart disease, stroke, and hypertensive disease - United States, 2001-2010

Abstract

Background: Deaths attributed to lack of preventive health care or timely and effective medical care can be considered avoidable. In this report, avoidable causes of death are either preventable, as in preventing cardiovascular events by addressing risk factors, or treatable, as in treating conditions once they have occurred. Although various definitions for avoidable deaths exist, studies have consistently demonstrated high rates in the United States. Cardiovascular disease is the leading cause of U.S. deaths (approximately 800,000 per year) and many of them (e.g., heart disease, stroke, and hypertensive deaths among persons aged <75 years) are potentially avoidable.

Methods: National Vital Statistics System mortality data for the period 2001-2010 were analyzed. Avoidable deaths were defined as those resulting from an underlying cause of heart disease (ischemic or chronic rheumatic), stroke, or hypertensive disease in decedents aged <75 years. Rates and trends by age, sex, race/ethnicity, and place were calculated.

Results: In 2010, an estimated 200,070 avoidable deaths from heart disease, stroke, and hypertensive disease occurred in the United States, 56% of which occurred among persons aged <65 years. The overall age-standardized death rate was 60.7 per 100,000. Rates were highest in the 65-74 years age group, among males, among non-Hispanic blacks, and in the South. During 2001-2010, the overall rate declined 29%, and rates of decline varied by age.

Conclusions: Nearly one fourth of all cardiovascular disease deaths are avoidable. These deaths disproportionately occurred among non-Hispanic blacks and residents of the South. Persons aged <65 years had lower rates than those aged 65-74 years but still accounted for a considerable share of avoidable deaths and demonstrated less improvement.

Implications for public health practice: National, state, and local initiatives aimed at improving health-care systems and supporting healthy behaviors are essential to reducing avoidable heart disease, stroke, and hypertensive disease deaths. Strategies include promoting the ABCS (aspirin when appropriate, blood pressure control, cholesterol management, and smoking cessation), reducing sodium consumption, and creating healthy environments.

FIGURE 1

Age-adjusted rates^* of avoidable death from heart disease, stroke, and hypertensive disease^† among non-Hispanic blacks and non-Hispanic whites, by sex — United States, 2001–2010 ^*Rates are age-standardized to the U.S. standard 2000 population. ^†Avoidable deaths from heart disease, stroke, and hypertensive disease are defined as all deaths occurring in persons aged <75 years with an underlying cause of ischemic heart disease, cerebrovascular disease, hypertensive disease, or chronic rheumatic heart disease.

FIGURE 2

Rates^* of avoidable death from heart disease, stroke, and hypertensive disease,^† by county — United States, 2008–2010^{§ *} Per 100,000 population. Rates are averaged over the 2008–2010 period and age-standardized to the U.S. standard 2000 population. Rates are spatially smoothed to enhance the stability of rates in counties with small populations. ^†Avoidable deaths from heart disease, stroke, and hypertensive disease are defined as all deaths occurring in persons aged <75 years with an underlying cause of ischemic heart disease, cerebrovascular disease, hypertensive disease, or chronic rheumatic heart disease. ^§Additional maps by race/ethnicity and sex are available on the Interactive Atlas for Heart Disease and Stroke at http://nccd.cdc.gov/dhdspatlas.