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

Abstract

Purpose Recent national trends show decelerating declines in heart disease mortality, especially among younger adults. National trends may mask variation by geography and age. We examined recent county-level trends in heart disease mortality by age group. Methods Using a Bayesian statistical model and National Vital Statistics Systems data, we estimated overall rates and percent change in heart disease mortality from 2010 through 2015 for four age groups (35–44, 45–54, 55–64, and 65–74 years) in 3098 US counties. Results Nationally, heart disease mortality declined in every age group except ages 55–64 years. County-level trends by age group showed geographically widespread increases, with 52.3%, 58.5%, 69.1%, and 42.0% of counties experiencing increases with median percent changes of 0.6%, 2.2%, 4.6%, and −1.5% for ages 35–44, 45–54, 55–64, and 65–74 years, respectively. Increases were more likely in counties with initially high heart disease mortality and outside large metropolitan areas. Conclusions Recent national trends have masked local increases in heart disease mortality. These increases, especially among adults younger than age 65 years, represent challenges to communities across the country. Reversing these trends may require intensification of primary and secondary prevention—focusing policies, strategies, and interventions on younger populations, especially those living in less urban counties.

Vital Signs: Prevalence of Key Cardiovascular Disease Risk Factors for Million Hearts 2022 — United States, 2011–2016

“…These findings suggest that in addition to universal strategies aimed at the entire population with and at risk for CVD, there is a need to focus action on high-burden, high-risk subsets of the population. For example, opportunities for risk factor prevention and management among younger adults are of particular importance given the increase in heart disease mortality observed from 2010 to 2015 among adults aged 35–64 years in approximately half of U.S. counties ( 3 ). Compared with adults aged ≥65 years, younger adults were less likely to be using aspirin or taking a statin when indicated and were more likely to use combustible tobacco and have an elevated daily sodium intake.…”

“…Despite steady declines in CVD mortality rates over approximately the last 40 years, heart disease and stroke remain the first and fifth leading causes of death in the United States, respectively, and their associated mortality rates have recently begun to plateau in the general population and even increase among some subpopulations. ( 1 – 3 ) Furthermore, CVD annually accounts for approximately $330 billion in direct and indirect costs in the United States: approximately one in seven health care dollars is spent on CVD ( 4 ). To address this burden, in 2012, the U.S. Department of Health and Human Services launched Million Hearts, a national initiative co-led by CDC and the Centers for Medicare & Medicaid Services, with the goal of preventing one million acute cardiovascular events over 5 years.…”

Vital Signs: State-Level Variation in Nonfatal and Fatal Cardiovascular Events Targeted for Prevention by Million Hearts 2022

“…Additionally, despite the considerable increase in risk for a cardiovascular event with increasing age, in 2016, over 800,000 combined hospitalizations and deaths occurred among adults aged <65 years (approximately one in three events). Other studies have shown that decades-long improvement in heart disease and stroke mortality have stalled ( 9 , 10 ) and that younger populations, especially those aged 35–64 years, are experiencing worse outcomes across the country ( 4 , 9 ). In 2016, Million Hearts-preventable event rates among persons aged 35–64 years varied considerably by demographic characteristics and U.S. state (Supplementary Table 3, https://stacks.cdc.gov/view/cdc/58172 ) ; among the overall 16.3 million events expected to occur during 2017–2021 if no additional action is taken, 5.0 million (30.9%) are expected to occur among this age group (Supplementary Figure 2, https://stacks.cdc.gov/view/cdc/58169 ).…”

“…However, despite decades-long improvement in outcomes, they remain leading causes of morbidity, mortality, and health care costs in the United States ( 2 ). Moreover, considerable disparities persist and recent evidence suggests that heart disease and stroke event rates are increasing among certain demographic groups, including adults aged 35–64 years ( 2 , 4 ). In response, CDC and the Centers for Medicare & Medicaid Services launched Million Hearts 2022, a national initiative working to prevent one million heart attacks, strokes, and other acute cardiovascular events during 2017–2021 ( 1 , 5 ).…”

“…This includes using strategies that improve the “ABCS” (aspirin when appropriate, blood pressure control, cholesterol management, and smoking cessation) of cardiovascular care; reducing sodium consumption, tobacco use, and physical inactivity; improving care among persons who have had cardiovascular events * ; and addressing known disparities in cardiovascular outcomes † ( 6 ). Despite their efficacy, implementation of these strategies throughout the country has been inconsistent, which might contribute to the disparities and geographic variation observed in cardiovascular disease (CVD) outcomes ( 2 , 4 ).…”