Ambar Kulshreshtha1, Abhinav Goyal2, Kaustubh Dabhadkar2, Emir Veledar2, Viola Vaccarino2. 1. 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. 2. 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.
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).
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).
Authors: Lee J Nedkoff; Tom G Briffa; David B Preen; Frank M Sanfilippo; Joseph Hung; Stephen C Ridout; Matthew Knuiman; Michael Hobbs Journal: Circ Cardiovasc Qual Outcomes Date: 2011-08-23
Authors: R Cooper; J Cutler; P Desvigne-Nickens; S P Fortmann; L Friedman; R Havlik; G Hogelin; J Marler; P McGovern; G Morosco; L Mosca; T Pearson; J Stamler; D Stryer; T Thom Journal: Circulation Date: 2000-12-19 Impact factor: 29.690
Authors: Adam S Vaughan; Michael R Kramer; Lance A Waller; Linda J Schieb; Sophia Greer; Michele Casper Journal: Ann Epidemiol Date: 2015-02-19 Impact factor: 3.797
Authors: Michael C Robertson; Jaejoon Song; Wendell C Taylor; Casey P Durand; Karen M Basen-Engquist Journal: J Rural Health Date: 2018-02-16 Impact factor: 4.333
Authors: Anna M Gorczyca; Richard A Washburn; Lauren Ptomey; Matthew S Mayo; Debra K Sullivan; Cheryl A Gibson; Robert Lee; Sarah Stolte; Joseph E Donnelly Journal: Contemp Clin Trials Date: 2018-02-15 Impact factor: 2.226
Authors: Erin R Weeda; Kinfe G Bishu; Ralph C Ward; Elizabeth A Brown; R Neal Axon; David J Taber; Mulugeta Gebregziabher Journal: Am J Cardiol Date: 2020-03-05 Impact factor: 2.778