Elsevier

Annals of Epidemiology

Volume 27, Issue 12, December 2017, Pages 796-800
Annals of Epidemiology

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

https://doi.org/10.1016/j.annepidem.2017.10.012Get rights and content

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.

Introduction

Over the past 40 years, heart disease mortality in the United States has declined sharply across race, gender, and age groups [1], [2], with similarly strong declines occurring at the county level [3], [4]. Recent national trends, however, indicate a slowing and even slight increase in heart disease mortality [5], [6], [7]. These slowing declines appear to be the most prominent among young adults [2], [6], a group that has also recently experienced increased all-cause and stroke mortality [8], [9], [10].

Prior studies of age-specific declines in heart disease mortality in the United States have focused on national trends, potentially masking changes in local age-specific patterns. Local trends, which have historically been strong but varied [3], [4], can provide important insights into potential drivers of population shifts in heart disease mortality and inform the development of tailored interventions. Therefore, using a period of marked leveling of national declines (2010–2015) [5], we examined recent county-level heart disease mortality trends by age group.

Section snippets

Methods

We obtained annual counts of county-level heart disease deaths during 2010–2015 from the National Vital Statistics System. Deaths with underlying causes of “diseases of the heart” were identified with the International Classification of Diseases, 10th revision (ICD-10) (codes I00–I09, I11, I13, I20–I51), including: rheumatic heart disease, hypertensive heart disease, ischemic heart disease, and pulmonary heart disease. The study population included residents of the 3098 counties in the

Results

Nationally, from 2010 to 2015, age-standardized heart disease mortality for ages 35–74 years declined slightly with a percent change of −1.6% (133.0 to 130.9 per 100,000 in 2010 and 2015, respectively) (Table 1). Nationally, rates slightly declined among adults at ages 35–44, 45–54, and 65–74 years, and increased among adults at ages 55–64 years.

In contrast to the national trends, at the county-level, from 2010 through 2015, the majority of counties experienced increases in heart disease

Discussion

This study of county-level trends in heart disease mortality from 2010 to 2015 reveals geographically dispersed, local increases across age groups. These trends, which have been masked in prior studies using national data and wider age groups [2], [6], vary in magnitude across counties and age groups. However, given the strong, consistent declines that have occurred since the 1970s, any leveling or increase in heart disease mortality is noteworthy [4], [5]. Our findings suggest that the

Conclusions

After over 40 years of declines at the national and county levels, the observed increases in heart disease mortality at the local level and by age group represent a challenge to individuals, communities, and the entire country. Enhanced prevention and treatment efforts tailored to the needs of communities are vital to prevent heart disease mortality, including an enhanced focus for younger, working-age adults, and for less urban areas.

Acknowledgments

The US Centers for Disease Control and Prevention supported this study. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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