County-level Disparities in US Cardiac Deaths Growing While Decline Slows Nationally

Declines in cardiac deaths are slowing, while county-level disparities are increasing, according to new research.

“Disparities in premature cardiac death (PCD) might stagnate the progress toward the reduction of PCD in the United States and worldwide,” the authors wrote, publishing in the Journal of the American Heart Association. We estimated disparities across US counties in PCD rates and investigated county‐level factors related to the disparities.”

The researchers pulled mortality data and cause-of-death from death certificate and county-level demographic information from multiple databases. The authors defined PCD as “any death that occured between ages 35 and 74 years with an underlying cause of death caused by cardiac disease based on International Classifications of Disease, Tenth Revision (ICD-10) codes.

There were 1,598,173 PCDs between 1999 and 2017. The proportion of out-of-hospital PCDs increased from 58.3% to 61.5%, and geographic disparities across counties increased from 1999 to 2017. Socioeconomic features, health care environment, and population health status were all among the disparities of out-of-hospital PCD rates linked with demographic composition.

“From the 1960s to 2010s, the United States experienced remarkable decline in cardiovascular disease mortality that was coined as one of the major public health accomplishments of the 20th century,” said lead investigator Zhi-Jie Zheng, MD, PhD, a University Endowed Distinguished Professor and chair of the department of global health at Peking University in Beijing, China, in a press release. “Increasing numbers of out-of-hospital deaths and fatal heart attacks in younger age groups, coupled with a steady widening of disparity of socioeconomic and health environment factors affecting health care at the county level, appear to be the key drivers of the slowdown we have seen since 2010.”

American Heart Association President Mitchell S.V. Elking, MD, MS, FAHA, FAAN, a professor of neurology and epidemiology at Columbia University, lamented the increase in PCDs reported in the study.

“The decline in the reduction of premature deaths attributable to heart disease is disheartening and is an urgent call to action,” he said in a press release. “We must invest and focus public and private efforts to address the disparities in risk factors, access to care and other factors slowing the progress in heart disease so that we can increase the opportunity for all Americans to live longer and healthier lives.”