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. 2019 Dec 1;4(12):1230-1238.
doi: 10.1001/jamacardio.2019.3891.

Association of Cardiovascular Disease With Premature Mortality in the United States

Yingxi Chen  1 , Neal D Freedman  1 , Paul S Albert  1 , Rachel R Huxley  2 , Meredith S Shiels  1 , Diana R Withrow  1 , Susan Spillane  1 , Tiffany M Powell-Wiley  3 , Amy Berrington de González  1
Affiliations

Association of Cardiovascular Disease With Premature Mortality in the United States

Yingxi Chen et al. JAMA Cardiol. .

Erratum in

  • Errors in X-Axis Labels in Figures 2 and 3.
    [No authors listed] [No authors listed] JAMA Cardiol. 2019 Dec 1;4(12):1301. doi: 10.1001/jamacardio.2019.5358. JAMA Cardiol. 2019. PMID: 31851282 Free PMC article. No abstract available.

Abstract

Importance: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the United States. Despite substantial declines in CVD mortality rates during past decades, progress against cardiovascular deaths in midlife has stagnated, with rates increased in some US racial/ethnic groups.

Objective: To examine the trends in premature (ages 25-64 years) mortality from CVD from 2000 to 2015 by demographics and county-level factors, including education, rurality, and the prevalence of smoking, obesity, and diabetes.

Design, setting, and participants: This descriptive study used US national mortality data from the Surveillance, Epidemiology, and End Results data set and included all CVD deaths among individuals ages 25 to 64 years from January 2000 to December 2015. The data analysis began in February 2018.

Exposures: Age, sex, race/ethnicity, and county-level factors.

Main outcomes and measures: Age-standardized mortality rates and average annual percent change (AAPC) in rates by age, sex, race/ethnicity, and county-level factors (in quintiles) and relative risks of CVD mortality across quintiles of each county-level factor.

Results: In 2000 to 2015, 2.3 million CVD deaths occurred among individuals age 25 to 64 years in the United States. There were significant declines in CVD mortality for black, Latinx, and Asian and Pacific Islander individuals (AAPC: range, -1.7 to -3.2%), although black people continued to have the highest CVD mortality rates. Mortality rates were second highest for American Indian/Alaskan Native individuals and increased significantly among those aged 25 to 49 years (AAPC: women, 2.1%; men, 1.3%). For white individuals, mortality rates plateaued among women age 25 to 49 years (AAPC, 0.05%). Declines in mortality rates were observed for most major CVD subtypes except for ischemic heart disease, which was stable in white women and increased in American Indian/Alaska Native women, hypertensive heart disease, for which significant increases in rates were observed in most racial/ethnic groups, and endocarditis, for which rates increased in white individuals and American Indian/Alaska Native men. Counties with the highest prevalence of diabetes (quintile 5 vs quintile 1: relative risk range 1.6-1.8 for white individuals and 1.4-1.6 for black individuals) had the most risk of CVD mortality.

Conclusions and relevance: There have been substantial declines in premature CVD mortality in much of the US population. However, increases in CVD mortality before age 50 years among American Indian/Alaska Native individuals, flattening rates in white people, and overall increases in deaths from hypertensive disease suggest that targeted public health interventions are needed to prevent these premature deaths.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Powell-Wiley reported grants from National Institutes of Health during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Average Annual Percentage Change of Cardiovascular Disease Mortality Rates Among White and Black Men Aged 50 to 64 Years by State, 2000 to 2015
Figure 2.
Figure 2.. Cardiovascular Disease (CVD) Mortality Average Annual Percentage Change Stratified by Age Group, Sex, and Race/Ethnicity Across Types of Disease, 2000 to 2015
Figure 3.
Figure 3.. County-Level Mortality Rates
A, Age-standardized all cardiovascular disease (CVD) mortality rates, 2012 to 2015. B, Average annual percentage change of all CVD mortality rates, 2000 to 2015.
Figure 4.
Figure 4.. Multivariate Quasi-Poisson Regression by County-Level Risk Factors, 2012 to 2015
See this image and copyright information in PMC

References

    1. Roth GA, Johnson CO, Abate KH, et al. ; Global Burden of Cardiovascular Diseases Collaboration . The burden of cardiovascular diseases among US states, 1990-2016. JAMA Cardiol. 2018;3(5):375-389. doi:10.1001/jamacardio.2018.0385 - DOI - PMC - PubMed
    1. Roth GA, Dwyer-Lindgren L, Bertozzi-Villa A, et al. . Trends and patterns of geographic variation in cardiovascular mortality among US counties, 1980-2014. JAMA. 2017;317(19):1976-1992. doi:10.1001/jama.2017.4150 - DOI - PMC - PubMed
    1. Patel SA, Winkel M, Ali MK, Narayan KM, Mehta NK. Cardiovascular mortality associated with 5 leading risk factors: national and state preventable fractions estimated from survey data. Ann Intern Med. 2015;163(4):245-253. doi:10.7326/M14-1753 - DOI - PubMed
    1. Singh GK, Siahpush M. Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25-64 years by area socioeconomic status, 1969-1998. Int J Epidemiol. 2002;31(3):600-613. doi:10.1093/ije/31.3.600 - DOI - PubMed
    1. Lloyd-Jones DM, Hong Y, Labarthe D, et al. ; American Heart Association Strategic Planning Task Force and Statistics Committee . Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121(4):586-613. doi:10.1161/CIRCULATIONAHA.109.192703 - DOI - PubMed

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