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Gonuguntla K, Badu I, Duhan S, Sandhyavenu H, Chobufo MD, Taha A, Thyagaturu H, Sattar Y, Keisham B, Ali S, Khan MZ, Latchana S, Naeem M, Shaik A, Balla S, Gulati M. Sex and Racial Disparities in Proportionate Mortality of Premature Myocardial Infarction in the United States: 1999 to 2020. J Am Heart Assoc 2024:e033515. [PMID: 38842272 DOI: 10.1161/jaha.123.033515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The incidence of premature myocardial infarction (PMI) in women (<65 years and men <55 years) is increasing. We investigated proportionate mortality trends in PMI stratified by sex, race, and ethnicity. METHODS AND RESULTS CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify PMI deaths within the United States between 1999 and 2020, and trends in proportionate mortality of PMI were calculated using the Joinpoint regression analysis. We identified 3 017 826 acute myocardial infarction deaths, with 373 317 PMI deaths corresponding to proportionate mortality of 12.5% (men 12%, women 14%). On trend analysis, proportionate mortality of PMI increased from 10.5% in 1999 to 13.2% in 2020 (average annual percent change of 1.0 [0.8-1.2, P <0.01]) with a significant increase in women from 10% in 1999 to 17% in 2020 (average annual percent change of 2.4 [1.8-3.0, P <0.01]) and no significant change in men, 11% in 1999 to 10% in 2020 (average annual percent change of -0.2 [-0.7 to 0.3, P=0.4]). There was a significant increase in proportionate mortality in both Black and White populations, with no difference among American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic people. American Indian/Alaska Natives had the highest PMI mortality with no significant change over time. CONCLUSIONS Over the last 2 decades, there has been a significant increase in the proportionate mortality of PMI in women and the Black population, with persistently high PMI in American Indian/Alaska Natives, despite an overall downtrend in acute myocardial infarction-related mortality. Further research to determine the underlying cause of these differences in PMI mortality is required to improve the outcomes after acute myocardial infarction in these populations.
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Affiliation(s)
| | - Irisha Badu
- Department of Medicine Onslow Memorial Hospital Jacksonville NC
| | - Sanchit Duhan
- Department of Medicine Sinai Hospital of Baltimore Baltimore MD
| | | | | | - Amro Taha
- Department of Medicine Weiss Memorial Hospital Chicago IL
| | | | - Yasar Sattar
- Department of Cardiology West Virginia University Morgantown WV
| | - Bijeta Keisham
- Department of Medicine Sinai Hospital of Baltimore Baltimore MD
| | - Shafaqat Ali
- Department of Internal Medicine Louisiana State University Shreveport LA
| | | | - Sharaad Latchana
- American University of Integrative Sciences School of Medicine Bridgetown Barbados
| | - Minahil Naeem
- Department of Internal Medicine King Edward Medical University Lahore Pakistan
| | - Ayesha Shaik
- Department of Cardiology Hartford Hospital Hartford CT
| | - Sudarshan Balla
- Department of Cardiology West Virginia University Morgantown WV
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women's Heart Center Smidt Heart Institute, Cedars Sinai Medical Center Los Angeles CA
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Yang H, Wang J, Li Y, Zhao M, Magnussen CG, Xi B. Trends in Cardiovascular Health Among US Adolescents Aged 12-19 Years Using the New "Life's Essential 8" Metrics, 2007-2018. J Adolesc Health 2024:S1054-139X(24)00161-7. [PMID: 38739053 DOI: 10.1016/j.jadohealth.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE The American Heart Association recently issued a substantial update to the definition and scoring of cardiovascular health (CVH), now called "Life's Essential 8" (LE8). We aimed to assess the trends in overall and individual LE8 CVH metrics among adolescents in the United States. METHODS A total of 6,999 United States adolescents aged 12-19 years from six cycles of the National Health and Nutrition Examination Survey from 2007-2008 to 2017-2018 were included in this study. The individual LE8 metrics included diet, physical activity, nicotine exposure, sleep health, body mass index (BMI), blood lipids, blood glucose, and blood pressure (BP). A higher CVH score indicates better CVH health. RESULTS The mean score of overall CVH significantly increased from 72.8 (95% confidence interval: 71.2-74.3) in 2007-2008 to 77.3 (76.1-78.5) in 2017-2018 in US adolescents (p-trend < .001). From 2007-2008 to 2017-2018, the mean scores increased from 75.5 (72.0-79.1) to 90.0 (88.0-91.9) for nicotine exposure, from 65.2 (61.6-68.8) to 73.3 (69.9-76.8) for sleep health, from 69.9 (67.1-72.8) to 73.0 (69.1-76.9) for blood lipids, and from 94.4 (93.0-95.9) to 96.2 (95.2-97.3) for BP (all p-trend < .05). However, the mean scores for diet, physical activity, and blood glucose did not significantly change (all p-trend > .05), whereas the mean score decreased from 81.4 (78.9-84.0) to 78.6 (76.4-80.8) for BMI (p-trend = .023). DISCUSSION In United States adolescents, the overall CVH and four components (nicotine exposure, sleep health, blood lipids, and BP) significantly improved over time, diet, physical activity, and blood glucose remained unchanged, whereas BMI worsened.
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Affiliation(s)
- Hui Yang
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiaxiang Wang
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Nguyen RT, Jain V, Acquah I, Khan SU, Parekh T, Taha M, Virani SS, Blaha MJ, Nasir K, Javed Z. Association of cardiovascular risk profile with premature all-cause and cardiovascular mortality in US adults: findings from a national study. BMC Cardiovasc Disord 2024; 24:91. [PMID: 38321396 PMCID: PMC10845615 DOI: 10.1186/s12872-023-03672-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE To assess the association between cardiovascular risk factor (CRF) profile and premature all-cause and cardiovascular disease (CVD) mortality among US adults (age < 65). METHODS This study used data from the National Health Interview Survey from 2006 to 2014, linked to the National Death Index for non-elderly adults aged < 65 years. A composite CRF score (range = 0-6) was calculated, based on the presence or absence of six established cardiovascular risk factors: hypertension, diabetes, hypercholesterolemia, smoking, obesity, and insufficient physical activity. CRF profile was defined as "Poor" (≥ 3 risk factors), "Average" (1-2), or "Optimal" (0 risk factors). Age-adjusted mortality rates (AAMR) were reported across CRF profile categories, separately for all-cause and CVD mortality. Cox proportional hazard models were used to evaluate the association between CRF profile and all-cause and CVD mortality. RESULTS Among 195,901 non-elderly individuals (mean age: 40.4 ± 13.0, 50% females and 70% Non-Hispanic (NH) White adults), 24.8% had optimal, 58.9% average, and 16.2% poor CRF profiles, respectively. Participants with poor CRF profile were more likely to be NH Black, have lower educational attainment and lower income compared to those with optimal CRF profile. All-cause and CVD mortality rates were three to four fold higher in individuals with poor CRF profile, compared to their optimal profile counterparts. Adults with poor CRF profile experienced 3.5-fold (aHR: 3.48 [95% CI: 2.96, 4.10]) and 5-fold (aHR: 4.76 [3.44, 6.60]) higher risk of all-cause and CVD mortality, respectively, compared to those with optimal profile. These results were consistent across age, sex, and race/ethnicity subgroups. CONCLUSIONS In this population-based study, non-elderly adults with poor CRF profile had a three to five-fold higher risk of all-cause and CVD mortality, compared to those with optimal CRF profile. Targeted prevention efforts to achieve optimal cardiovascular risk profile are imperative to reduce the persistent burden of premature all-cause and CVD mortality in the US.
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Affiliation(s)
- Ryan T Nguyen
- Department of Medicine, Houston Methodist, Houston, TX, US
| | - Vardhmaan Jain
- Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA, US
| | - Isaac Acquah
- Methodist DeBakey Heart and Vascular Center, Houston, TX, US
| | - Safi U Khan
- Methodist DeBakey Heart and Vascular Center, Houston, TX, US
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, US
| | - Tarang Parekh
- Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston, US
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, US
| | - Mohamad Taha
- Methodist DeBakey Heart and Vascular Center, Houston, TX, US
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, US
| | - Salim S Virani
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
- Department of Cardiology, Texas Heart Institute, Baylor College of Medicine, Houston, TX, US
| | - Michael J Blaha
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, US
| | - Khurram Nasir
- Methodist DeBakey Heart and Vascular Center, Houston, TX, US
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, US
- Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston, US
| | - Zulqarnain Javed
- Center for Cardiovascular Computational Health and Precision Medicine, Houston Methodist, Houston, TX, USA.
- Houston Methodist Academic Institute, Houston, TX, USA.
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Zuin M, Bilato C, Nguyen T, Daggubati R, Rigatelli G. Demographic and Regional Trends of Cardiogenic Shock-Related Mortality in Young Adults in the United States, 1999 to 2019. Am J Cardiol 2024; 211:94-97. [PMID: 37949340 DOI: 10.1016/j.amjcard.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/23/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Thach Nguyen
- Cardiovascular Research, Methodist Hospital, Merrillville, Indiana
| | - Ramesh Daggubati
- West Virginia University School of Medicine, Heart and Vascular Institute, Morgantown, West Virginia
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Chaganty SS, Abramov D, Van Spall HG, Bullock-Palmer RP, Vassiliou V, Myint PK, Bang V, Kobo O, Mamas MA. Rural and urban disparities in cardiovascular disease-related mortality in the USA over 20 years; have the trends been reversed by COVID-19? INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200202. [PMID: 37675096 PMCID: PMC10477062 DOI: 10.1016/j.ijcrp.2023.200202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Saisunder S. Chaganty
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke- on-Trent, UK
| | - Dmitry Abramov
- International Heart Institute, Loma Linda University, Loma Linda, CA, USA
| | - Harriette G.C. Van Spall
- Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - Vassilios Vassiliou
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, And Norfolk and Norwich Hospital, NR4 7TJ, UK
| | - Phyo Kyaw Myint
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Vijay Bang
- Oriion Citicare Hospital, Aurangabad, India
| | - Ofer Kobo
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke- on-Trent, UK
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke- on-Trent, UK
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Zuin M, Bikdeli B, Armero A, Porio N, Rigatelli G, Bilato C, Piazza G. Trends in Pulmonary Embolism Deaths Among Young Adults Aged 25 to 44 Years in the United States, 1999 to 2019. Am J Cardiol 2023; 202:169-175. [PMID: 37441831 DOI: 10.1016/j.amjcard.2023.06.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/06/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023]
Abstract
A concerning increase in mortality from acute pulmonary embolism (PE) in young adults in the United States has been reported. We extracted PE-related mortality rates (number of deaths per US population) from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2019, focusing on subjects aged 25 to 44 years. Age-adjusted mortality rates (AAMRs) were assessed using the Joinpoint regression modeling and expressed as the estimated average annual percentage change (AAPC) with relative 95% confidence intervals (95% CIs) and stratified by urbanization, gender, age, and race. Between 1999 and 2019, the AAMR from acute PE in US adults aged 25 to 44 years linearly increased without any difference between genders (AAPC +1.5%, 95% CI 1.2 to 1.8, p <0.001). AAMR increase was more pronounced in American-Indians/Alaska Natives and in Asian/Pacific Islanders (AAPC +2.5%, 95% CI 1.6 to 3.4, p <0.001), Whites (AAPC +1.7%, 95% CI 1.4 to 2.0, p <0.001), Latinx/Hispanic patients (AAPC +1.7%, 95% CI 0.6 to 3.0, p = 0.003), and residents of rural areas (AAPC +2.4%, 95% CI 1.9 to 2.8, p <0.001). A higher AAMR (4.02 per 100,000 residents, 95% CI 3.90 to 4.15) and absolute number of PE-related deaths were observed in the South. PE-related mortality in adults aged 25 to 44 years has increased over the last 2 decades in the United States. Stratification by race, ethnicity, urbanization, and census region showed ethnoracial and regional disparities that will require further evaluation and remedy.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
| | - Behnood Bikdeli
- Cardiovascular Medicine Division and Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, Connecticut
| | - Andre Armero
- Cardiovascular Medicine Division and Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole Porio
- Cardiovascular Medicine Division and Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Gregory Piazza
- Cardiovascular Medicine Division and Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Allen N, Wilkins JT. The Urgent Need to Refocus Cardiovascular Disease Prevention Efforts on Young Adults. JAMA 2023; 329:886-887. [PMID: 36871231 DOI: 10.1001/jama.2023.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Norrina Allen
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John T Wilkins
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Gaye B, Hergault H, Lassale C, Ladouceur M, Valentin E, Vignac M, Danchin N, Diaw M, Kvaskoff M, Chamieh S, Thomas F, Michos ED, Jouven X. Gender gap in annual preventive care services in France. EClinicalMedicine 2022; 49:101469. [PMID: 35747180 PMCID: PMC9156877 DOI: 10.1016/j.eclinm.2022.101469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In France, screening for cardiovascular risk factors is recommended during annual preventive visits. However, data are lacking on the temporal trend in women's uptake to preventive care services, and in cardiovascular and mortality outcomes. The aim of the study was to investigate the participation and mortality of women in annual preventive care services in a major preventive medicine center in France. METHOD Ee conducted repeated cross-sectional studies including a total of 366,270 individuals who had a first examination at the Centre d'Investigations Préventives et Cliniques, France, between January 1992 and December 2011. FINDINGS Women's participation was low below 50 years of age, then increases from 50 to 70 years, and is lower for women older than 70 years. The gap in female participation was more pronounced among individuals with high education, low social deprivation, and no depressive symptoms. Compared with the general population, the screened population had significantly lower standardized mortality ratios (SMRs) among both men and women, for all age ranges. Screened women aged 18-49 years showed a lower mortality gain compared with men of the same age; SMRs did not differ significantly by sex for individuals over 50 years. INTERPRETATION In this community-based sample, compared with men, women's participation to annual preventive care services was lower, and screened women had a lower mortality gain. Despite the demonstrated benefit of annual check-ups on health, there is a gender gap in adherence to preventive programs and in efficiency of screening programs, especially in the young age range. This gap in cardiovascular disease prevention may result in poorer cardiovascular health in women. Urgent adaptations to overcome this gender gap in preventive screening in France are warranted. FUNDING Bamba Gaye is supported by the Fondation Recherche Médicale grant.
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Affiliation(s)
- Bamba Gaye
- INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
- Corresponding author at: INSERM U970, Paris Cardiovascular Research Center (PARCC), Team 4 Integrative Epidemiology of Cardiovascular Disease, Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France, 56 rue Leblanc, 75015, Paris, France.
| | - Hélène Hergault
- AP-HP, Ambroise Paré Hospital, Cardiology Department, Paris, France
| | - Camille Lassale
- Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - Magalie Ladouceur
- INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
- Preventive and Clinical Investigation Center, Paris, France
| | - Eugenie Valentin
- INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
| | - Maxime Vignac
- INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
| | - Nicolas Danchin
- AP-HP, Georges Pompidou European Hospital, Cardiology Department, Paris, France
| | - Mor Diaw
- Laboratoire de Physiologie et Explorations Fonctionnelles, FMPO - UCAD, Dakar, Sénégal
- IRL3189 Environnement, santé, sociétés CNRS/UCAD Dakar/ UGB Saint-Louis/ USTTB Bamako/ CNRST Ouagadougou
| | - Marina Kvaskoff
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France,
- Gustave Roussy, F-94805, Villejuif, France
| | - Sarah Chamieh
- INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
| | - Frederique Thomas
- AP-HP, Georges Pompidou European Hospital, Cardiology Department, Paris, France
| | - Erin D. Michos
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland, United States
| | - Xavier Jouven
- INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
- AP-HP, Georges Pompidou European Hospital, Cardiology Department, Paris, France
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Nguyen RT, Khan SU, Valero-Elizondo J, Cainzos-Achirica M, Nasir K. Association of Income Status with Stroke in Non-Elderly Adults in the United States, 2012-2018. Curr Probl Cardiol 2022:101235. [DOI: 10.1016/j.cpcardiol.2022.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 11/24/2022]
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10
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Khan SU, Lone AN, Yedlapati SH, Dani SS, Khan MZ, Watson KE, Parwani P, Rodriguez F, Cainzos-Achirica M, Michos ED. Cardiovascular Disease Mortality Among Hispanic Versus Non-Hispanic White Adults in the United States, 1999 to 2018. J Am Heart Assoc 2022; 11:e022857. [PMID: 35362334 PMCID: PMC9075497 DOI: 10.1161/jaha.121.022857] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Life expectancy has been higher for Hispanic versus non‐Hispanic White (NHW) individuals; however, data are limited on cardiovascular disease (CVD) mortality. Method and Results Using the Centers for Disease Control and Prevention’s Wide‐Ranging Online Data for Epidemiologic Research death certificate database (1999–2018), we compared age‐adjusted mortality rates for total CVD and its subtypes (ischemic heart disease, stroke, heart failure, hypertensive heart disease, other CVD), and average annual percentage changes among Hispanic and NHW adults. The age‐adjusted mortality rate per 100 000 was lower for Hispanic than NHW adults for total CVD (186.4 versus 254.6; P<0.001) and its subtypes. Between 1999 and 2018, mortality decline was higher in Hispanic than NHW adults for total CVD (average annual percentage change [AAPC], −2.90 versus −2.41) and ischemic heart disease (AAPC: −4.44 versus −3.82) (P<0.001). In contrast, stroke mortality decline was slower in Hispanic versus NHW adults (AAPC: −2.05 versus −2.60; P<0.05). Stroke mortality increased in Hispanic but stalled in NHW adults since 2011 (AAPC: 0.79 versus −0.09). For ischemic heart disease (AAPC: −0.80 versus −1.85) and stroke (AAPC: −1.32 versus −1.43) mortality decline decelerated more for Hispanic than NHW adults aged <45 years (P<0.05). For heart failure, Hispanic adults aged <45 (3.55 versus 2.16) and 45 to 64 (1.88 versus 1.54) showed greater rise in age‐adjusted mortality rate than NHW individuals (P<0.05). Age‐adjusted heart failure mortality rate also accelerated in Hispanic versus NHW men (1.00 versus 0.67; P<0.001). Conclusions Disaggregating data by CVD subtype and demographics unmasked heterogeneities in CVD mortality between Hispanic and NHW adults. NHW adults had greater CVD mortality rates and slower decline than Hispanic adults, whereas marked demographic differences in mortality signaled concerning trends among the Hispanic versus NHW population.
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Affiliation(s)
- Safi U Khan
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX
| | - Ahmad N Lone
- Department of Cardiovascular Medicine Guthrie Health System/Robert Packer Hospital Sayre PA
| | | | - Sourbha S Dani
- Division of Cardiology Lahey Hospital and Medical CenterBeth Israel Lahey Health Burlington MA
| | - Muhammad Zia Khan
- Department of Cardiovascular Medicine West Virginia University Morgantown WV
| | - Karol E Watson
- Division of Cardiology David Geffen School of Medicine at UCLA Los Angeles CA
| | - Purvi Parwani
- Division of Cardiology Loma Linda University Loma Linda CA
| | - Fatima Rodriguez
- Division of Cardiology and the Cardiovascular Institute Stanford University Stanford CA
| | - Miguel Cainzos-Achirica
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Erin D Michos
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
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11
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Dani SS, Lone AN, Javed Z, Khan MS, Zia Khan M, Kaluski E, Virani SS, Shapiro MD, Cainzos-Achirica M, Nasir K, Khan SU. Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019. J Am Heart Assoc 2021; 11:e021682. [PMID: 34935456 PMCID: PMC9075205 DOI: 10.1161/jaha.121.021682] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Evaluating premature (<65 years of age) mortality because of acute myocardial infarction (AMI) by demographic and regional characteristics may inform public health interventions. Methods and Results We used the Centers for Disease Control and Prevention’s WONDER (Wide‐Ranging Online Data for Epidemiologic Research) death certificate database to examine premature (<65 years of age) age‐adjusted AMI mortality rates per 100 000 and average annual percentage change from 1999 to 2019. Overall, the age‐adjusted AMI mortality rate was 13.4 (95% CI, 13.3–13.5). Middle‐aged adults, men, non‐Hispanic Black adults, and rural counties had higher mortality than young adults, women, NH White adults, and urban counties, respectively. Between 1999 and 2019, the age‐adjusted AMI mortality rate decreased at an average annual percentage change of −3.4 per year (95% CI, −3.6 to −3.3), with the average annual percentage change showing higher decline in age‐adjusted AMI mortality rates among large (−4.2 per year [95% CI, −4.4 to −4.0]), and medium/small metros (−3.3 per year [95% CI, −3.5 to −3.1]) than rural counties (−2.4 per year [95% CI, −2.8 to −1.9]). Age‐adjusted AMI mortality rates >90th percentile were distributed in the Southern states, and those with mortality <10th percentile were clustered in the Western and Northeastern states. After an initial decline between 1999 and 2011 (−4.3 per year [95% CI, −4.6 to −4.1]), the average annual percentage change showed deceleration in mortality since 2011 (−2.1 per year [95% CI, −2.4 to −1.8]). These trends were consistent across both sexes, all ethnicities and races, and urban/rural counties. Conclusions During the past 20 years, decline in premature AMI mortality has slowed down in the United States since 2011, with considerable heterogeneity across demographic groups, states, and urbanicity. Systemic efforts are mandated to address cardiovascular health disparities and outcomes among nonelderly adults.
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Affiliation(s)
- Sourbha S Dani
- Division of Cardiology Lahey Hospital, and Medical CenterBeth Israel Lahey Health Burlington MA
| | - Ahmad N Lone
- Department of Cardiology Guthrie Health System/Robert Packer Hospital Sayre PA
| | - Zulqarnain Javed
- Division of Health Equity & Disparities Research, Center for Outcomes Research Houston Methodist Houston TX
| | - Muhammad S Khan
- Department of Cardiovascular Medicine Duke University Durham NC
| | - Muhammad Zia Khan
- Department of Cardiovascular Medicine West Virginia University Morgantown WV
| | - Edo Kaluski
- Department of Cardiology Guthrie Health System/Robert Packer Hospital Sayre PA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research Department of Medicine Baylor College of Medicine Houston TX
| | - Michael D Shapiro
- Section on Cardiovascular Medicine Wake Forest University School of Medicine Winston-Salem NC
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research Houston Methodist Houston TX.,Department of CardiologyHouston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Khurram Nasir
- Division of Health Equity & Disparities Research, Center for Outcomes Research Houston Methodist Houston TX.,Department of CardiologyHouston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Safi U Khan
- Center for Outcomes Research Houston Methodist Houston TX
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12
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Khan SU, Kalra A, Yedlapati SH, Dani SS, Shapiro MD, Nasir K, Virani SS, Michos ED, Alkhouli M. Stroke-Related Mortality in the United States-Mexico Border Area of the United States, 1999 to 2018. J Am Heart Assoc 2021; 10:e019993. [PMID: 34212760 PMCID: PMC8403284 DOI: 10.1161/jaha.120.019993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The United States (US)-Mexico border is a socioeconomically underserved area. We sought to investigate whether stroke-related mortality varies between the US border and nonborder counties. METHODS AND RESULTS We used death certificates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database to examine stroke-related mortality in border versus nonborder counties in California, Texas, New Mexico, and Arizona. We measured average annual percent changes (AAPCs) in age-adjusted mortality rates (AAMRs) per 100 000 between 1999 and 2018. Overall, AAMRs were higher for nonborder counties, older adults, men, and non-Hispanic Black adults than their counterparts. Between 1999 and 2018, AAMRs reduced from 55.8 per 100 000 to 34.4 per 100 000 in the border counties (AAPC, -2.70) and 64.5 per 100 000 to 37.6 per 100 000 in nonborder counties (AAPC, -2.92). The annual percent change in AAMR initially decreased, followed by stagnation in both border and nonborder counties since 2012. The AAPC in AAMR decreased in all 4 states; however, AAMR increased in California's border counties since 2012 (annual percent change, 3.9). The annual percent change in AAMR decreased for older adults between 1999 and 2012 for the border (-5.10) and nonborder counties (-5.01), followed by a rise in border counties and stalling in nonborder counties. Although the AAPC in AAMR decreased for both sexes, the AAPC in AAMR differed significantly for non-Hispanic White adults in border (-2.69) and nonborder counties (-2.86). The mortality decreased consistently for all other ethnicities/races in both border and nonborder counties. CONCLUSIONS Stroke-related mortality varied between the border and nonborder counties. Given the substantial public health implications, targeted interventions aimed at vulnerable populations are required to improve stroke-related outcomes in the US-Mexico border area.
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Affiliation(s)
- Safi U. Khan
- Department of MedicineWest Virginia UniversityMorgantownWV
| | - Ankur Kalra
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
- Regional Section of Interventional CardiologyCardiovascular ResearchCleveland Clinic Akron GeneralAkronOH
| | | | - Sourbha S. Dani
- Department of CardiologyLahey Hospital & Medical CenterBurlingtonMA
| | - Michael D. Shapiro
- Section on Cardiovascular MedicineWake Forest University School of MedicineWinston‐SalemNC
| | - Khurram Nasir
- Department of CardiologyHouston Methodist DeBakey Heart & Vascular CenterHoustonTX
| | - Salim S. Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular ResearchDepartment of MedicineBaylor College of MedicineHoustonTX
| | - Erin D. Michos
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
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13
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Michos ED, Khan SS. Further understanding of ideal cardiovascular health score metrics and cardiovascular disease. Expert Rev Cardiovasc Ther 2021; 19:607-617. [PMID: 34053373 DOI: 10.1080/14779072.2021.1937127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The American Heart Association (AHA) introduced the construct of 'cardiovascular health (CVH)', to focus on primordial prevention to reduce the burden of cardiovascular disease (CVD). The CVH score includes seven health and behavioral metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, blood glucose), which are characterized as being ideal, intermediate, or poor. AREAS COVERED In this review, we describe the utility of the CVH score for monitoring and promoting wellness, overall and by key sociodemographic groups, and for tracking of temporal trends. EXPERT OPINION Notably, the seven factors are all modifiable, which differs from 10-year CVD risk scores that include non-modifiable components such as age, sex, and race. Numerous epidemiological studies have shown that achievement of a greater number of ideal CVH metrics is associated with lower incidences of CVD, cardiovascular mortality, and all-cause mortality. Longer duration of favorable CVH is associated with greater longevity and compressed morbidity. Nevertheless, the prevalence of favorable CVH is low, with <20% of U.S. adults meeting ≥5 metrics at ideal levels and significant racial/ethnic disparities persist. Many challenges must be overcome to improve CVH at individual and societal levels if the AHA Impact Goals are to be fully realized.
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Affiliation(s)
- Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sadiya S Khan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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14
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Khan SU, Yedlapati SH, Lone AN, Khan MS, Wenger NK, Watson KE, Gulati M, Hays AG, Michos ED. A comparative analysis of premature heart disease- and cancer-related mortality in women in the USA, 1999-2018. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:315-323. [PMID: 33555018 DOI: 10.1093/ehjqcco/qcaa099] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/25/2020] [Accepted: 12/30/2020] [Indexed: 12/28/2022]
Abstract
AIMS To compare premature heart disease- and cancer-related deaths in women in the USA. METHODS AND RESULTS We analysed the US national database of death certificates of women aged <65 from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database between 1999 and 2018. We measured annual percentage changes (APCs) in age-adjusted mortality rates (AAMRs) and years of potential life lost per 100 000 persons due to heart disease and cancer. Overall, cancer was a more prevalent cause of premature death compared with heart disease. Between 1999 and 2018, the AAMRs decreased for both cancer (61.9/100 000 to 45.6/100 000) and heart disease (29.2/100 000 to 22.6/100 000). However, while APC in AAMR for cancer declined consistently over time, after an initial decline, APC in AAMR for heart disease increased between 2010 and 2018 [0.53 95% confidence interval (0.18-0.89)], with a significant rise in Midwest, medium/small metros, and rural areas after 2008. Compared with cancer, APC in AAMR for heart disease increased in women aged 25-34 years [2.24 (0.30-4.22); 2013-18) and 55-64 years [0.46 (0.13-0.80); 2009-13], as well as Non-Hispanic (NH) Whites [APC, 0.79 (0.46-1.13); 2009-18] and NH American Indian/Alaskan Native [2.71 (0.59-4.87); 2011-2018]. Consequently, the mortality gap between cancer and heart disease has narrowed from an AAMR of 32.7/100 000 to 23.0/100 000. CONCLUSIONS The mortality gap between cancer and heart disease is decreasing among women <65 years. Intensive cardiovascular health interventions are required focusing on vulnerable young demographic subgroups and underserved regional areas to meet the American Heart Association's Impact Goal and Million Hearts Initiative.
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Affiliation(s)
- Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Siva H Yedlapati
- Department of Medicine, Erie County Medical Center, Buffalo, NY, USA
| | - Ahmad N Lone
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Karol E Watson
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Martha Gulati
- Department of Medicine, Division of Cardiology, University of Arizona, Phoenix, AZ, USA
| | - Allison G Hays
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Blalock 524-B, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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15
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Khan SU, Khan MS, Navar AM, Warraich HJ, Singh J, Cainzos-Achirica M, Michos ED. The Changing Profile of Autopsies in Cardiovascular Deaths in the United States, 2003-2018. Am J Cardiol 2021; 140:150-151. [PMID: 33250153 DOI: 10.1016/j.amjcard.2020.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
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16
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Okunrintemi V, Tibuakuu M, Virani SS, Sperling LS, Volgman AS, Gulati M, Cho L, Leucker TM, Blumenthal RS, Michos ED. Sex Differences in the Age of Diagnosis for Cardiovascular Disease and Its Risk Factors Among US Adults: Trends From 2008 to 2017, the Medical Expenditure Panel Survey. J Am Heart Assoc 2020; 9:e018764. [PMID: 33161825 PMCID: PMC7955360 DOI: 10.1161/jaha.120.018764] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022]
Abstract
Background Sex differences in the trends for control of cardiovascular disease (CVD) risk factors have been described, but temporal trends in the age at which CVD and its risk factors are diagnosed and sex-specific differences in these trends are unknown. Methods and Results We used the Medical Expenditure Panel Survey 2008 to 2017, a nationally representative sample of the US population. Individuals ≥18 years, with a diagnosis of hypercholesterolemia, hypertension, coronary heart disease, or stroke, and who reported the age when these conditions were diagnosed, were included. We included 100 709 participants (50.2% women), representing 91.9 million US adults with above conditions. For coronary heart disease and hypercholesterolemia, mean age at diagnosis was 1.06 and 0.92 years older for women, compared with men, respectively (both P<0.001). For stroke, mean age at diagnosis for women was 1.20 years younger than men (P<0.001). The mean age at diagnosis of CVD risk factors became younger over time, with steeper declines among women (annual decrease, hypercholesterolemia [women, 0.31 years; men 0.24 years] and hypertension [women, 0.23 years; men, 0.20 years]; P<0.001). Coronary heart disease was not statistically significant. For stroke, while age at diagnosis decreased by 0.19 years annually for women (P=0.03), it increased by 0.22 years for men (P=0.02). Conclusions The trend in decreasing age at diagnosis for CVD and its risk factors in the United States appears to be more pronounced among women. While earlier identification of CVD risk factors may provide opportunity to initiate preventive treatment, younger age at diagnosis of CVD highlights the need for the prevention of CVD earlier in life, and sex-specific interventions may be needed.
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Affiliation(s)
| | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
| | | | | | | | - Martha Gulati
- Division of CardiologyUniversity of Arizona School of MedicinePhoenixAZ
| | - Leslie Cho
- Department of Cardiovascular MedicineCleveland ClinicClevelandOH
| | - Thorsten M. Leucker
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular DiseaseJohns Hopkins UniversityBaltimoreMD
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Age-specific differences in patient reported outcomes among adults with atherosclerotic cardiovascular disease: Medical expenditure panel survey 2006-2015. Am J Prev Cardiol 2020; 3:100083. [PMID: 34327463 PMCID: PMC8315315 DOI: 10.1016/j.ajpc.2020.100083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/09/2020] [Accepted: 08/20/2020] [Indexed: 12/02/2022] Open
Abstract
Objective The prevalence of atherosclerotic cardiovascular disease (ASCVD) in younger adults has increased over the past decade. However, it is less well established whether patient reported outcomes differ between younger and older adults with ASCVD. We sought to evaluate age-specific differences in patient reported outcomes among adults with ASCVD. Methods This was a retrospective cross-sectional survey study. We used data from the 2006–2015 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of the United States population. Adults ≥18 years with a diagnosis of ASCVD, ascertained by ICD9 codes or self-reported data, were included. Logistic regression was used to compare self-reported patient-clinician communication, patient satisfaction, perception of health, emergency department (ED) visits, and use of preventive medications (aspirin and statins) by age category [Young: 18–44, Middle: 45–64, Older: ≥65 years]. We used two-part econometric modeling to evaluate age-specific annual healthcare expenditure. Results There were 21,353 participants included. Over 9000 (42.6%-weighted) of the participants were young or middle aged, representing ~9.9 million adults aged <65 years with ASCVD nationwide. Compared with older adults, middle-aged and young adults with ASCVD were more likely to report poor patient-clinician communication [OR 1.73 (95% CI 1.28–2.33) and 2.49 (1.76–3.51), respectively], poor healthcare satisfaction, and poor perception of health status, have increased ED utilization and were also less likely to be using aspirin and statins. The mean annual healthcare expenditure was highest among middle-aged adults [$10,798 (95% CI, $10,012 to $11,583)]. Conclusion Compared with older adults, younger adults with ASCVD were more likely to report poor patient experience and poor health status and less likely to be using preventive medications. More effort needs to be geared towards understanding the age-specific differences in healthcare quality and delivery to improve outcomes among high-risk young adults with ASCVD. In a sample of US adults with ASCVD we compared young & middle-age to older adults. Young adults were more likely to report poor healthcare communication & satisfaction. Young adults at a higher risk for depression and have poorer health perception. Young adults with ASCVD were less likely to be using aspirin and statins. More effort needed to understanding age-specific differences in patient experience.
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