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. 2020 Nov 3;9(21):e017433.
doi: 10.1161/JAHA.120.017433. Epub 2020 Oct 19.

Demographic, Regional, and State-Level Trends of Mortality in Patients With Aortic Stenosis in United States, 2008 to 2018

Safi U Khan  1 , Ankur Kalra  2   3 , Samir R Kapadia  2 , Muhammad U Khan  1 , Muhammad Zia Khan  1 , Muhammad Shahzeb Khan  4 , Mamas A Mamas  5   6 , Haider J Warraich  7 , Khurram Nasir  8 , Erin D Michos  9   10 , Mohamad Alkhouli  11
Affiliations

Demographic, Regional, and State-Level Trends of Mortality in Patients With Aortic Stenosis in United States, 2008 to 2018

Safi U Khan et al. J Am Heart Assoc. .

Abstract

Background Aortic stenosis-related mortality might vary across demographic subsets, regions, and states in the United States. Methods and Results We reviewed the death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research database to examine aortic stenosis-related mortality trends from 2008 to 2018. Crude and age-adjusted mortality rates (AAMRs) per 100 000 people and annual percentage change with 95% CIs were calculated. Between 2008 and 2018, AAMR reduced from 12.7 to 11.5 (average annual percentage change, -1.0 [95% CI, -1.5 to -0.5]), because of an accelerated decline between 2015 and 2018 (annual percentage change, -4.4 [95% CI, -6.0 to -2.7]). Older (aged >85 years), male, and White patients had higher death rates than younger, female, and non-White patients, respectively. Although mortality reduction was similar across sexes, significant mortality reduction was limited to White patients only. The AAMRs were higher in rural than urban areas. States with AAMRs >90th percentile were distributed in the West and the Northeast, and <10th percentile in the South. The AAMRs for sex and race were highest in the West and lowest in the South. None of the states located in the Midwest showed a significant reduction in mortality. Mortality remained stable for hospital setting and nursing home/long-term care facility, except that the number of deaths increased at home and hospice facility since 2014. Conclusions The reduction in mortality in patients with aortic stenosis was not consistent among demographic subsets and states. The substantial public health and economic implications call for determination of underlying clinical and socioeconomic factors to narrow the gap.

Keywords: aortic stenosis; epidemiology; mortality.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1. Overall and sex‐stratified aortic stenosis–related mortality rates in the United States, 2008 to 2018.
*Indicates that the annual percentage change (APC) is significantly different from zero at α=0.05.
Figure 2
Figure 2
Aortic stenosis–related mortality rates in the US regions by age and sex, 2008 to 2018.
Figure 3
Figure 3. Aortic stenosis–related mortality rates stratified by race in the United States, 2008 to 2018.
*Indicates that the annual percentage change (APC) is significantly different from zero at α=0.05.
Figure 4
Figure 4
State‐level aortic stenosis–related age‐adjusted mortality rates per 100 000 people among adults aged ≥45 years in the United States, 2008 to 2018.
Figure 5
Figure 5
Sex and age‐specific aortic stenosis–related crude mortality rates per 100 000 people in the US regions, 2008 to 2018.
See this image and copyright information in PMC

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