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Comparative Study
. 2018 Jul;131(7):829-836.e1.
doi: 10.1016/j.amjmed.2018.02.014. Epub 2018 Apr 2.

Comparative Trends in Heart Disease, Stroke, and All-Cause Mortality in the United States and a Large Integrated Healthcare Delivery System

Stephen Sidney  1 , Michael E Sorel  2 , Charles P Quesenberry  2 , Marc G Jaffe  3 , Matthew D Solomon  4 , Mai N Nguyen-Huynh  5 , Alan S Go  6 , Jamal S Rana  7
Affiliations
Comparative Study

Comparative Trends in Heart Disease, Stroke, and All-Cause Mortality in the United States and a Large Integrated Healthcare Delivery System

Stephen Sidney et al. Am J Med. 2018 Jul.

Abstract

Objectives: Heart disease and stroke remain among the leading causes of death nationally. We examined whether differences in recent trends in heart disease, stroke, and total mortality exist in the United States and Kaiser Permanente Northern California (KPNC), a large integrated healthcare delivery system.

Methods: The main outcome measures were comparisons of US and KPNC total, age-specific, and sex-specific changes from 2000 to 2015 in mortality rates from heart disease, coronary heart disease, stroke, and all causes. The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research data system was used to determine US mortality rates. Mortality rates for KPNC were determined from health system, Social Security vital status, and state death certificate databases.

Results: Declines in age-adjusted mortality rates were noted in KPNC and the United States for heart disease (36.3% in KPNC vs 34.6% in the United States), coronary heart disease (51.0% vs 47.9%), stroke (45.5% vs 38.2%), and all-cause mortality (16.8% vs 15.6%). However, steeper declines were noted in KPNC than the United States among those aged 45 to 65 years for heart disease (48.3% KPNC vs 23.6% United States), coronary heart disease (55.6% vs 35.9%), stroke (55.8% vs 26.0%), and all-cause mortality (31.5% vs 9.1%). Sex-specific changes were generally similar.

Conclusions: Despite significant declines in heart disease and stroke mortality, there remains an improvement gap nationally among those aged less than 65 years when compared with a large integrated healthcare delivery system. Interventions to improve cardiovascular mortality in the vulnerable middle-aged population may play a key role in closing this gap.

Keywords: Heart disease; Mortality rate; Stroke.

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Conflict of interest statement

Conflicts of Interest: Dr. Sidney reports grants from National Heart, Lung and Blood Institute, and NINDS during the conduct of the study. Dr. Go reports grants from the National Heart, Lung and Blood Institute during the conduct of the study. Dr. Nguyen-Huynh reports grants from NINDS, outside the submitted work. Drs. Jaffe, Quesenberry, Solomon, Rana and Mr. Sorel have nothing to disclose. All authors had access to the data and a role in writing the manuscript.

Figures

Figure
Figure
Decline in age-adjusted mortality rates (% change) from 2000 to 2015, United States versus KPNC. KPNC = Kaiser Permanente Northern California.
See this image and copyright information in PMC

References

    1. Sidney S, Quesenberry CP, Jr, Jaffe MG, Sorel M, Nguyen-Huynh MN, Kushi LH, Go AS, Rana JS. Recent Trends in Cardiovascular Mortality in the United States and Public Health Goals. JAMA Cardiol. 2016 Aug 1;1(5):594–9. - PubMed
    1. Sidney S, Quesenberry CP, Jr, Jaffe MG, Sorel M, Go AS, Rana JS. Heterogeneity in national U.S. mortality trends within heart disease subgroups, 2000–2015. BMC Cardiovasc Disord. 2017 Jul 18;17(1):192. - PMC - PubMed
    1. Yang Q, Tong X, Schieb L, Vaughan A, Gillespie C, Wiltz JL, King SC, Odom E, Merritt R, Hong Y, George MG. Vital Signs: Recent Trends in Stroke Death Rates - United States, 2000–2015. MMWR Morb Mortal Wkly Rep. 2017 Sep 8;66(35):933–939. - PMC - PubMed
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    1. Jaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved blood pressure control associated with a large-scale hypertension program. JAMA. 2013 Aug 21;310(7):699–705. - PMC - PubMed

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