Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2016 Mar 22;133(12):1171-80.
doi: 10.1161/CIRCULATIONAHA.115.018663.

Changes in the Geographic Patterns of Heart Disease Mortality in the United States: 1973 to 2010

Michele Casper  1 , Michael R Kramer  2 , Harrison Quick  2 , Linda J Schieb  2 , Adam S Vaughan  2 , Sophia Greer  2
Affiliations
Comparative Study

Changes in the Geographic Patterns of Heart Disease Mortality in the United States: 1973 to 2010

Michele Casper et al. Circulation. .

Abstract

Background: Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality.

Methods and results: Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged ≥35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases. A fully Bayesian spatiotemporal model was used to produce precise rate estimates, even in counties with small populations. A substantial shift in the concentration of high-rate counties from the Northeast to the Deep South was observed, along with a concentration of slow-decline counties in the South and a nearly 2-fold increase in the geographic inequality among counties.

Conclusions: The dramatic change in the geographic patterns of heart disease mortality during 40 years highlights the importance of small-area surveillance to reveal patterns that are hidden at the national level, gives communities the historical context for understanding their current burden of heart disease, and provides important clues for understanding the determinants of the geographic disparities in heart disease mortality.

Keywords: epidemiology; heart diseases; mapping; mortality.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Age-standardized heart disease death rates, ages ≥35, by county and quintile ranking for the beginning (1973–1974, A) and end (2009–2010, B) of the study period.
Figure 2
Figure 2
Clusters of county-level age-standardized heart disease death rates, ages ≥35 for the beginning (1973–1974, A) and end (2009–2010, B) of the study period.
Figure 3
Figure 3
Percentage of counties in the top quintile of heart disease mortality by region for the beginning (1973–1974), middle (1991–1992), and end (2009–2010) of the study period.
Figure 4
Figure 4
Percentage decline in age-standardized heart disease death rates, ages ≥35, by county, from 1973–1974 to 2009–2010.
Figure 5
Figure 5
Clusters of county-level declines in age-standardized heart disease death rates, ages ≥35 from the beginning (1973–1974) to the end (2009–2010) of the study period.
Figure 6
Figure 6
Temporal trend of the coefficient of variation (CoV) for age-standardized county-level heart disease death rates, United States, from 1973–1974 to 2009–2010. Larger CoV indicates greater geographic disparity in heart disease death rates among counties.
See this image and copyright information in PMC

Comment in

References

    1. Greenlund K, Giles W, Keenan N, Malarcher A, Zheng Z, Casper M, Heath G, Croft J, Ward J, Warren C. Heart disease and stroke mortality in the twentieth century. In: Ward JW, Warren C, editors. Silent Victories: The History and Practice of Public Health in Twentieth-Century America. New York, NY: Oxford University Press; 2007. pp. 381–400.
    1. Kramer MR, Valderrama AL, Casper ML. Decomposing black-white disparities in heart disease mortality in the U.S., 1973–2010: an age-period-cohort analysis. Am J Epidemiol. 2015;182:302–312. doi: 10.1093/aje/kwv050. Epub 2015 Jul 20. - DOI - PMC - PubMed
    1. Sempos C, Cooper R, Kovar MG, McMillen M. Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States. Am J Public Health. 1988;78:1422–1427. - PMC - PubMed
    1. Enterline PE, Stewart WH. Geographic patterns in deaths from coronary heart disease. Public Health Rep. 1956;71:849–855. - PMC - PubMed
    1. Barnett E, Halverson J. Local increases in coronary heart disease mortality among blacks and whites in the United States, 1985–1995. Am J Public Health. 2001;91:1499–1506. - PMC - PubMed

Publication types