Changes in the Geographic Patterns of Heart Disease Mortality in the United States

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.

Widespread recent increases in county-level heart disease mortality across age groups

“…These trends, which have been masked in prior studies using national data and wider age groups [2,6], vary in magnitude across counties and age groups. However, given the strong, consistent declines that have occurred since the 1970s, any leveling or increase in heart disease mortality is noteworthy [4,5]. Our findings suggest that the warnings issued about the potential implications of stagnating heart disease mortality among young adults during the latter part of the last century appear to have come to fruition [16], with over 50% of counties experiencing increases in heart disease mortality from 2010 through 2015 among adults aged 35–64 years.…”

“…Specifically, increases were focused in medium and small metropolitan areas and in rural counties, which could lead to a widening of the urban-rural disparity that began in the mid-2000s [19]. Finally, many counties well outside the belt of high-burden Southern counties [4] experienced increased heart disease mortality, raising questions about the nature and pervasiveness of conditions responsible for increasing heart disease mortality. Are the conditions contributing to increased heart disease mortality similar across regions and across age groups?…”

“…Over the past 40 years, heart disease mortality in the United States has declined sharply across race, gender, and age groups [1,2], with similarly strong declines occurring at the county level [3,4]. Recent national trends, however, indicate a slowing and even slight increase in heart disease mortality [5–7].…”

“…Local trends, which have historically been strong but varied [3,4], can provide important insights into potential drivers of population shifts in heart disease mortality and inform the development of tailored interventions. Therefore, using a period of marked leveling of national declines (2010–2015) [5], we examined recent county-level heart disease mortality trends by age group.…”

Precision medicine in cardiology

“…However, cardiovascular disease remains the lead ing cause of death in the USA -on average one death from cardiovascular disease occurs every 40 s 5 . In addi tion, marked regional variations exist within countries 6 , and the rates of cardiovascular disease related deaths are much higher in lowincome and middleincome countries than in highincome countries 7,8 . Considerable variation within countries is also seen with respect to age, race, ethnicity, and geographical location 1,9 .…”