Despite overall decline in premature CVD deaths, certain groups see increase
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Rates of CVD mortality have been on the decline across the U.S., but researchers found that this trend may not be representative of all subgroups, according to a recent study published in JAMA Cardiology.
Researchers studying U.S. national CVD mortality data from the SEER data set found that overall CVD mortality declined 20% in both men and women aged 25 to 64 years between 2000 and 2015 (average annual percentage change [AAPC, –1.8% men; –1.9% women), but observed significant variation among racial/ethnic groups.
According to the findings, among women, black individuals experienced the highest age-standardized CVD mortality rates from 2012 to 2015 (101 per 100,000 people) and were followed by American Indian/Alaska Native (74 per 100,000), white (44 per 100,000), Latin American (28 per 100,000) and lastly, Asian Pacific Islander women experience the lowest rates (19 per 100,000). Although white women aged 25 to 49 years did not have the highest overall incidence of CVD mortality, the rate of decline in that group plateaued (AAPC, 0.05%).
Moreover, among men, the highest age-standardized mortality rates were experienced by black individuals (190 per 100,000) and followed by American Indian/Alaska Native (161 per 100,000), white (100 per 100,000), Latin American (69 per 100,000) and lastly, Asian Pacific Islander men experienced the lowest rates (55 per 100,000), according to the study.
“Identifying groups with increasing CVD mortality rates is important to guide targeted prevention efforts,” Yingxi Chen, MD, PhD, postdoctoral fellow in the radiation epidemiology branch at the National Cancer Institute, and colleagues wrote. “Recent work identifies important areas of research to better understand the high rates of CVD mortality among American Indian and Alaska Native populations, including work to elucidate the association of adverse childhood experiences and other psychosocial factors with CVD in these communities.”
In other findings, ischemic heart disease (54% of all CVD premature deaths), cerebrovascular disease (13%) and hypertensive heart disease (10%) were the largest contributors to premature deaths due to CVD in the U.S. from 2000 to 2015.
Researchers observed overall declines in age-standardized mortality rates from cerebrovascular disease (4.5% to 0.4%), peripheral artery disease (5.5% to 0.1%) and rheumatic heart disease (6.6% to 0.3%). However, prevalence of mortality from ischemic heart disease had risen among American Indian/Alaska Native women aged 25 to 49 years (AAPC, 1.7%).
Age-standardized mortality rates from hypertensive heart disease increased across most racial/ethnic groups as well as in nearly every U.S. state, except for Washington, D.C. (2.5%) and Vermont (1.6%), according to the study.
“[These findings reflect] a lack of progress against mortality from ischemic heart disease and increases in mortality rates from hypertensive heart disease and endocarditis in these groups,” the researchers wrote.
Although black men had greater declines in age-standardized CVD mortality across all U.S. states except for Utah (AAPC, 2.8%), white women aged 25 to 49 years showed significant variations in AAPCs, which ranged from 3.3% in Oregon to 2.3% in Alabama.
Researchers also found that age-standardized CVD mortality was 1.4 times higher among white individuals and 1.3 times higher among black individuals who lived in counties with diabetes prevalence of 9.8% to 10.6% compared with women who were aged 25 to 49 years and lived in counties with a prevalence of 5% to 8.5%, according to the study.
Researchers analyzed all CVD deaths in the U.S. among individuals aged 25 to 64 years using data from the SEER data set. Their aim was to observe trends in premature CVD death by studying demographics as well as county-level factors.
“Mortality from hypertensive heart disease is a growing concern that affects most groups. Counties with a high prevalence of obesity, diabetes and smoking have continued to experience higher rates of mortality and should be targeted for intervention,” the authors wrote. “Although CVD risk factors are modifiable, sustained efforts at such interventions are needed. Without rapid and sustained progress against CV risk factors, public health goals to further reduce the burden of CVD mortality in the United States are unlikely to be met.” – by Scott Buzby
Disclosure s : One author reports receiving grants from NIH during the conduct of the study. Chen and the other authors report no relevant financial disclosures.
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