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Casper M, Kramer MR, Quick H, Schieb LJ, Vaughan AS, Greer S. Changes in the Geographic Patterns of Heart Disease Mortality in the United States: 1973 to 2010. Circulation 2016; 133:1171-80. [PMID: 27002081 PMCID: PMC4836838 DOI: 10.1161/circulationaha.115.018663] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Michele Casper
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.).
| | - Michael R Kramer
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.)
| | - Harrison Quick
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.)
| | - Linda J Schieb
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.)
| | - Adam S Vaughan
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.)
| | - Sophia Greer
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.)
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Kulshreshtha A, Goyal A, Dabhadkar K, Veledar E, Vaccarino V. Urban-rural differences in coronary heart disease mortality in the United States: 1999-2009. Public Health Rep 2014; 129:19-29. [PMID: 24381356 DOI: 10.1177/003335491412900105] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Coronary heart disease (CHD) mortality has declined in the past few decades; however, it is unclear whether the reduction in CHD deaths has been similar across urbanization levels and in specific racial groups. We describe the pattern and magnitude of urban-rural variations in CHD mortality in the U.S. METHODS Using data from the National Center for Health Statistics, we examined trends in death rates from CHD from 1999 to 2009 among people aged 35-84 years, in each geographic region (Northeast, Midwest, West, and South) and in specific racial-urbanization groups, including black and white people in large and medium metropolitan (urban) areas and in non-metropolitan (rural) areas. We also examined deaths from early-onset CHD in females aged <65 years and males aged <55 years. RESULTS From 1999 to 2009, there was a 40% decline in age-adjusted CHD mortality. The trend was similar in black and white people but was more pronounced in urban than in rural areas, resulting in a crossover in 2007, when rural areas began showing a higher CHD mortality than urban areas. White people in large metropolitan areas had the largest decline (43%). Throughout the study period, CHD mortality remained higher in black people than in white people, and, in the South, it remained higher in rural than in urban areas. For early-onset CHD, the mortality decline was more modest (30%), but overall trends by urbanization and region were similar. CONCLUSION Favorable national trends in CHD mortality conceal persisting disparities for some regions and population subgroups (e.g., rural areas and black people).
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Affiliation(s)
- Ambar Kulshreshtha
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Family and Preventive Medicine, Atlanta, GA
| | - Abhinav Goyal
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
| | - Kaustubh Dabhadkar
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
| | - Emir Veledar
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
| | - Viola Vaccarino
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
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Barnett E, Halverson J. Local increases in coronary heart disease mortality among blacks and whites in the United States, 1985-1995. Am J Public Health 2001; 91:1499-506. [PMID: 11527788 PMCID: PMC1446811 DOI: 10.2105/ajph.91.9.1499] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2000] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study analyzed coronary heart disease (CHD) mortality trends from 1985 to 1995, by race and sex, among Black and White adults 35 years and older to determine whether adverse trends were evident in any US localities. METHODS Log-linear regression models of annual age-adjusted death rates provided a quantitative measure of local mortality trends. RESULTS Increasing trends in CHD mortality were observed in 11 of 174 labor market areas for Black women, 23 of 175 areas for Black men, 10 of 394 areas for White women, and 4 of 394 areas for White men. Nationwide, adverse trends affected 1.7% of Black women, 8.0% of Black men, 1.1% of White women, and 0.3% of White men. CONCLUSIONS From 1985 to 1995, moderate to strong local increases in CHD mortality were observed, predominantly in the southern United States. Black men evidenced the most unfavorable trends and were 25 times as likely as White men to be part of a local population experiencing increases in coronary heart disease mortality.
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Affiliation(s)
- E Barnett
- Department of Community Medicine, West Virginia University, Morgantown, USA.
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Barnett E, Strogatz D, Armstrong D, Wing S. Urbanisation and coronary heart disease mortality among African Americans in the US South. J Epidemiol Community Health 1996; 50:252-7. [PMID: 8935454 PMCID: PMC1060279 DOI: 10.1136/jech.50.3.252] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE Despite significant declines since the late 1960s, coronary mortality remains the leading cause of death for African Americans. African Americans in the US South suffer higher rates of cardiovascular disease than African Americans in other regions; yet the mortality experiences of rural-dwelling African Americans, most of whom live in the South, have not been described in detail. This study examined urban-rural differentials in coronary mortality trends among African Americans for the period 1968-86. SETTING The United States South, comprising 16 states and the District of Columbia. STUDY POPULATION African American men and women aged 35-74 years. DESIGN Analysis of urban-rural differentials in temporal trends in coronary mortality for a 19 year study period. All counties in the US South were grouped into five categories: greater metropolitan, lesser metropolitan, adjacent to metropolitan, semirural, and isolated rural. Annual age adjusted mortality rates were calculated for each urban status group. In 1968, observed excesses in coronary mortality were 29% for men and 45% for women, compared with isolated rural areas. Metropolitan areas experienced greater declines in mortality than rural areas, so by 1986 the urban-rural differentials in coronary mortality were 3% for men and 11% for women. CONCLUSIONS Harsh living conditions in rural areas of the South precluded important coronary risk factors and contributed to lower mortality rates compared with urban areas during the 1960s. The dramatic transformation from an agriculturally based economy to manufacturing and services employment over the course of the study period contributed to improved living conditions which promoted coronary mortality declines in all areas of the South; however, the most favourable economic and mortality trends occurred in metropolitan areas.
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Affiliation(s)
- E Barnett
- Prevention Research Center, West Virginia University, Morgantown 26506-9005, USA
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Sprafka JM, Folsom AR, Burke GL, Edlavitch SA. Prevalence of cardiovascular disease risk factors in blacks and whites: the Minnesota Heart Survey. Am J Public Health 1988; 78:1546-9. [PMID: 3263810 PMCID: PMC1349732 DOI: 10.2105/ajph.78.12.1546] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two cross-sectional surveys were conducted in 1985 and 1986 to measure the prevalence of coronary heart disease (CHD) risk factors in Blacks and Whites. A home interview was followed by a survey center visit. Participation rates were 78 per cent and 90 per cent for the home interview and 65 per cent and 68 per cent for the survey center visit. Adjusted for age and education, systolic and diastolic blood pressure was 3 to 4 mmHg higher in Blacks. Hypertension was more prevalent in Blacks than Whites (44 per cent vs 28 per cent); serum total cholesterol was approximately 0.4 mmol/l lower in Black than White men and 0.08 mmol/l lower in Black than White women. Among men, more Blacks than Whites were current cigarette smokers (44 per cent vs 30 per cent); however, White smokers smoked more cigarettes per day (26 vs 17). Similar differences were noted for women, although the prevalence and quantity of cigarette consumption was less than men. The excess prevalence of these CHD risk factors in Blacks, especially among women, may explain their elevated CHD and stroke mortality rates in the Twin Cities.
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Affiliation(s)
- J M Sprafka
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55455
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Bruce RA, Fisher LD, Hossack KF. Validation of exercise-enhanced risk assessment of coronary heart disease events: longitudinal changes in incidence in Seattle community practice. J Am Coll Cardiol 1985; 5:875-81. [PMID: 3871803 DOI: 10.1016/s0735-1097(85)80426-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Noninvasive criteria developed in a learning series for exercise-enhanced risk assessment for events due to coronary heart disease have been applied to a test series in a later population sample. Men in the same age and risk groups for each pretest clinical classification show similar gradients of risk. Thus, exercise-enhanced criteria for risk assessment are validated. Age-standardized event rates show a reduction longitudinally in healthy men and patients who have had coronary bypass surgery.
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