State-Level Cardiovascular Mortality Rates Among Hispanic, Non-Hispanic Black, and Non-Hispanic White Populations, 1990 to 2019

Abstract

ImportanceCardiovascular disease (CVD) is the leading cause of death in the US, with considerable variation by both state and race and ethnicity group. Consistent, comparable measures of mortality by specific CVD cause at the state level and by race and ethnicity have not previously been available and are necessary for supporting policy decisions aimed at reducing health inequities.ObjectiveTo quantify and describe levels and trends of mortality due to overall CVD and its component causes for 3 mutually exclusive race and ethnicity groups and by state.Design, Setting, and ParticipantsThis cross-sectional study used Census data, population surveys, and US vital registration records to estimate cause-specific cardiovascular mortality by state and by the following race and ethnicity groups, defined by the US Office of Management and Budget: Hispanic of any race, non-Hispanic Black (hereafter, Black), and non-Hispanic White (hereafter, White). Data were analyzed from January 2020 to September 2022.ExposuresState of residence at time of death; Hispanic ethnicity and Black or White race.Main Outcomes and MeasuresCVD death counts and mortality rates.ResultsAn estimated 25 397 029 persons died of cardiovascular diseases from 1990 to 2019. The mean (SD) age of individuals was 78.20 (14.01); 13 087 290 individuals (51.53%) were female and 12 309 739 (48.47%) were male; 2 921 650 (11.50%) were Black, 1 159 498 (4.57%) were Hispanic, and 21 315 880 (83.93%) were White. Age-standardized CVD mortality per 100 000 persons in 2019 was 194.4 (95% uncertainty interval [UI], 172.7 to 207.4), 107.7 (95% UI, 92.9 to 121.4), and 153.8 (95% UI, 133.8 to 163.8) among Black, Hispanic, and White populations, respectively. The median (IQR) percentage change across states was smaller for 2010 to 2019 compared with 1990 to 2000 for both White female and White male populations (−6.8 [−10.1 to −4.3] vs −10.2 [−12.9 to −5.9] and −4.6 [−8.6 to −2.5] vs −16.5 [−19.3 to −15.4]). For the Black and Hispanic groups, the percentage change (IQR) was larger for the female populations for the latter time period (−15.1 [−18.9 to −11.7] vs −12.6 [−19.6 to −7.8] and −23.5 [−29.2 to −18.5] vs −8.2 [−17.8 to 5.96]). The converse was observed among male individuals in both groups, with smaller percentage change (IQR) values in 2010 to 2019 compared with 1990 to 2000 (−13.1 [−18.7 to −8.6] vs −18.6 [−25.5 to −14.7] among the Black male population and −20.4 [−25.6 to −15.6] vs −21.5 [−31.1 to −5.7] among the Hispanic male population). There was substantial variability at the state level for death due to total CVD and component causes in 2019 and changes in CVD mortality from 1990 through 2019.Conclusions and RelevanceThe findings of this study indicate that CVD mortality varied widely by state and race and ethnicity group. Changes over the time period were not consistent for all groups and varied by cardiovascular subcause. These results highlight ongoing health disparities in cardiovascular mortality.

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“…95% confidence intervals are in parentheses. *** p<0.001, ** p<0.01, * p<0.05 c Predicted outpatient pharmacy expenditures are subset of total outpatient expenditures reported in column (2). Outpatient pharmacy expenditure estimates were obtained using GLM regression with gamma distribution and loglink for fully-adjusted model with overlap propensity score-weights among those who had positive outpatient pharmacy expenditures during 2021.…”

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