Disparities in Temporal and Geographic Patterns of Declining Heart Disease Mortality by Race and Sex in the United States, 1973–2010

Vaughan, Adam S.; Quick, Harrison; Pathak, Elizabeth B; Kramer, Michael R.; Casper, Michele

doi:10.1161/jaha.115.002567

Cited by 45 publications

(50 citation statements)

References 60 publications

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“…Studies have documented state-level disparities in declining heart disease death rates from 1999 to 2007, 8 geographic disparities among state economic areas in the onset of declining heart disease mortality in the 1960s and 1970s, 12 slower rates of declines among Metropolitan Statistical Areas for black women and men in comparison with white women and men from 1985 to 1995, 5 the impact of model choice on measuring spatiotemporal disparities in heart disease mortality at the county level, 11 and the timing of declines by race and sex. 25 …”

Section: Discussionmentioning

confidence: 99%

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

et al. 2016

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Background Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality. Methods and Results Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged ≥35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases. A fully Bayesian spatiotemporal model was used to produce precise rate estimates, even in counties with small populations. A substantial shift in the concentration of high-rate counties from the Northeast to the Deep South was observed, along with a concentration of slow-decline counties in the South and a nearly 2-fold increase in the geographic inequality among counties. Conclusions The dramatic change in the geographic patterns of heart disease mortality during 40 years highlights the importance of small-area surveillance to reveal patterns that are hidden at the national level, gives communities the historical context for understanding their current burden of heart disease, and provides important clues for understanding the determinants of the geographic disparities in heart disease mortality.

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Section: Discussionmentioning

confidence: 99%

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

et al. 2016

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“…It is estimated that there are over 300 000 out‐of‐hospital, nontraumatic cardiac arrests in the United States annually . Though survival has increased dramatically over the past 15 years, overall mortality remains very high . Data from the Cardiac Arrest Registry to Enhance Survival demonstrate modest improvements in risk‐adjusted out‐of‐hospital cardiac arrest survival rates over the last decade, from 5.7% in 2005 to 8.3% in 2012.…”

Section: Introductionmentioning

confidence: 99%

“…1 Though survival has increased dramatically over the past 15 years, overall mortality remains very high. 2,3 Data from the Cardiac Arrest Registry to Enhance Survival demonstrate modest improvements in risk-adjusted out-of-hospital cardiac arrest survival rates over the last decade, from 5.7% in 2005 to 8.3% in 2012. Patients with shockable rhythms (ventricular tachycardia [VT] and ventricular fibrillation [VF]) expectedly have the best survival rates, whereas survival for pulseless electrical activity (PEA) or asystole remains poor.…”

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Sex‐Based Disparities in Incidence, Treatment, and Outcomes of Cardiac Arrest in the United States, 2003–2012

Kim

Looser

Swaminathan

et al. 2016

JAHA

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BackgroundRecent studies have shown improving survival after cardiac arrest. However, data regarding sex‐based disparities in treatment and outcomes after cardiac arrest are limited.Methods and ResultsWe performed a retrospective analysis of all patients suffering cardiac arrest between 2003 and 2012 using the Nationwide Inpatient Sample database. Annual rates of cardiac arrest, rates of utilization of coronary angiography/percutaneous coronary interventions/targeted temperature management, and sex‐based outcomes after cardiac arrest were examined. Among a total of 1 436 052 discharge records analyzed for cardiac arrest patients, 45.4% (n=651 745) were females. Women were less likely to present with ventricular tachycardia/ventricular fibrillation arrests compared with men throughout the study period. The annual rates of cardiac arrests have increased from 2003 to 2012 by 14.0% (P trend<0.001) and ventricular tachycardia/ventricular fibrillation arrests have increased by 25.9% (P trend<0.001). Women were less likely to undergo coronary angiography, percutaneous coronary interventions, or targeted temperature management in both ventricular tachycardia/ventricular fibrillation and pulseless electrical activity/asystole arrests. Over a 10‐year study period, there was a significant decrease in in‐hospital mortality in women (from 69.1% to 60.9%, P trend<0.001) and men (from 67.2% to 58.6%, P trend<0.001) after cardiac arrest. In‐hospital mortality was significantly higher in women compared with men (64.0% versus 61.4%; adjusted odds ratio 1.02, P<0.001), particularly in the ventricular tachycardia/ventricular fibrillation arrest cohort (49.4% versus 45.6%; adjusted odds ratio 1.11, P<0.001).ConclusionsWomen presenting with cardiac arrests are less likely to undergo therapeutic procedures, including coronary angiography, percutaneous coronary interventions, and targeted temperature management. Despite trends in improving survival after cardiac arrest over 10 years, women continue to have higher in‐hospital mortality when compared with men.

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“…Sempos et al (1988) and Kramer et al (2015)), by race (e.g. Kramer et al (2015) and Vaughan et al (2015b)) and geographically (e.g. Gillum et al (2012) and Vaughan et al (2015a, b)), but accounting for these various sources of disparities simultaneously has yet to be considered.…”

Section: Introductionmentioning

confidence: 99%

A Multivariate Space–Time Model for Analysing County Level Heart Disease Death Rates by Race and Sex

Quick

Waller

Casper

2017

Journal of the Royal Statistical Society Series C: Applied Statistics

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Summary. Although death rates from heart disease have declined sharply over the past 50 years, the rate of decline varies by location, race and sex. Despite these declines, heart disease continues to be the leading cause of death in the USA. We propose a non-separable multivariate spatiotemporal Bayesian model to obtain a clearer picture of the temporally varying trends in county level heart disease death rates for men and women of different races in the USA. After verifying the effectiveness of our model via simulation, we apply our model to a data set of over 230000 county level heart disease death rates.

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Disparities in Temporal and Geographic Patterns of Declining Heart Disease Mortality by Race and Sex in the United States, 1973–2010

Cited by 45 publications

References 60 publications

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

Sex‐Based Disparities in Incidence, Treatment, and Outcomes of Cardiac Arrest in the United States, 2003–2012

A Multivariate Space–Time Model for Analysing County Level Heart Disease Death Rates by Race and Sex

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