AbstractObjectiveTo describe trends in the burden of mortality due to subtypes of heart disease from 1999 to 2018 to inform targeted prevention strategies and reduce disparities.DesignSerial cross ...sectional analysis of cause specific heart disease mortality rates using national death certificate data in the overall population as well as stratified by race-sex, age, and geography.SettingUnited States, 1999-2018.Participants12.9 million decedents from total heart disease (49% women, 12% black, and 19% <65 years old).Main outcome measuresAge adjusted mortality rates (AAMR) and years of potential life lost (YPLL) for each heart disease subtype, and respective mean annual percentage change.ResultsDeaths from total heart disease fell from 752 192 to 596 577 between 1999 and 2011, and then increased to 655 381 in 2018. From 1999 to 2018, the proportion of total deaths from heart disease attributed to ischemic heart disease decreased from 73% to 56%, while the proportion attributed to heart failure increased from 8% to 13% and the proportion attributed to hypertensive heart disease increased from 4% to 9%. Among heart disease subtypes, AAMR was consistently highest for ischemic heart disease in all subgroups (race-sex, age, and region). After 2011, AAMR for heart failure and hypertensive heart disease increased at a faster rate than for other subtypes. The fastest increases in heart failure mortality were in black men (mean annual percentage change 4.9%, 95% confidence interval 4.0% to 5.8%), whereas the fastest increases in hypertensive heart disease occurred in white men (6.3%, 4.9% to 9.4%). The burden of years of potential life lost was greatest from ischemic heart disease, but black-white disparities were driven by heart failure and hypertensive heart disease. Deaths from heart disease in 2018 resulted in approximately 3.8 million potential years of life lost.ConclusionsTrends in AAMR and years of potential life lost for ischemic heart disease have decelerated since 2011. For almost all other subtypes of heart disease, AAMR and years of potential life lost became stagnant or increased. Heart failure and hypertensive heart disease account for the greatest increases in premature deaths and the largest black-white disparities and have offset declines in ischemic heart disease. Early and targeted primary and secondary prevention and control of risk factors for heart disease, with a focus on groups at high risk, are needed to avoid these suboptimal trends beginning earlier in life.
Adults in rural counties in the United States (US) experience higher rates broadly of cardiovascular disease (CVD) compared with adults in urban counties. Mortality rates specifically due to heart ...failure (HF) have increased since 2011, but estimates of heterogeneity at the county-level in HF-related mortality have not been produced. The objectives of this study were 1) to quantify nationwide trends by rural-urban designation and 2) examine county-level factors associated with rural-urban differences in HF-related mortality rates.
We queried CDC WONDER to identify HF deaths between 2011-2018 defined as CVD (I00-78) as the underlying cause of death and HF (I50) as a contributing cause of death. First, we calculated national age-adjusted mortality rates (AAMR) and examined trends stratified by rural-urban status (defined using 2013 NCHS Urban-Rural Classification Scheme), age (35-64 and 65-84 years), and race-sex subgroups per year. Second, we combined all deaths from 2011-2018 and estimated incidence rate ratios (IRR) in HF-related mortality for rural versus urban counties using multivariable negative binomial regression models with adjustment for demographic and socioeconomic characteristics, risk factor prevalence, and physician density. Between 2011-2018, 162,314 and 580,305 HF-related deaths occurred in rural and urban counties, respectively. AAMRs were consistently higher for residents in rural compared with urban counties (73.2 95% CI: 72.2-74.2 vs. 57.2 56.8-57.6 in 2018, respectively). The highest AAMR was observed in rural Black men (131.1 123.3-138.9 in 2018) with greatest increases in HF-related mortality in those 35-64 years (+6.1%/year). The rural-urban IRR persisted among both younger (1.10 1.04-1.16) and older adults (1.04 1.02-1.07) after adjustment for county-level factors. Main limitations included lack of individual-level data and county dropout due to low event rates (<20).
Differences in county-level factors may account for a significant amount of the observed variation in HF-related mortality between rural and urban counties. Efforts to reduce the rural-urban disparity in HF-related mortality rates will likely require diverse public health and clinical interventions targeting the underlying causes of this disparity.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk ...factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).
The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.
Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.
The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
This study evaluates the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research to compare trends in heart disease, stroke, diabetes, and hypertension ...mortality rates by race and sex from 1999 to 2017.
Asian Americans are the fastest growing racial/ethnic minority group in the United States and have unique, heterogenous health status and outcomes across a range of conditions between disaggregated ...Asian subgroups. Despite the rapid growth of this group, clinical and epidemiologic research lags considerably in adequately and appropriately representing Asian Americans. Too often, Asian American participants and populations are inappropriately aggregated into a single race category in research, masking important differences between ethnic subgroups. In this commentary, actionable recommendations are provided to investigators in order to enhance inclusion and representation of Asian Americans in a broad scope of research programs. Incorporating these recommendations in research planning and conduct will support health and promote health equity for these populations.
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BFBNIB, NMLJ, NUK, PNG, UL, UM, UPUK
Background
Diabetes mellitus (DM) is a leading contributor to morbidity and mortality in the United States (US). Prior DM prevalence estimates in Asian Americans are predominantly from Asians ...aggregated into a single group, but the Asian American population is heterogenous.
Objective
To evaluate self-reported DM prevalence in disaggregated Asian American subgroups to inform targeted management and prevention.
Design
Serial cross-sectional analysis.
Participants
Respondents to the US Behavioral Risk Factor Surveillance System surveys who self-identify as non-Hispanic Asian American (NHA,
N
=57,001), comprising Asian Indian (
N
=11,089), Chinese (
N
=9458), Filipino (
N
=9339), Japanese (
N
=10,387), and Korean Americans (
N
=2843), compared to non-Hispanic White (NHW,
N=
2,143,729) and non-Hispanic Black (NHB,
N
=215,957) Americans.
Main Measures
Prevalence of self-reported DM. Univariate Satterthwaite-adjusted chi-square tests compared the differences in weighted DM prevalence by sociodemographic and health status.
Key Results
Self-reported fully adjusted DM prevalence was 8.7% (95% confidence interval 8.2–9.3) in NHA, compared to 14.3% (14.0–14.6) in NHB and 10.0% (10.0–10.1) in NHW (
p
<0.01 for difference). In NHA subgroups overall, DM prevalence was 14.4% (12.6–16.3) in Filipino, 13.4% (10.9–16.2) in Japanese, 10.7% (9.6–11.8) in Asian Indian, 5.1% (4.2–6.2) in Chinese, and 4.7% (3.4–6.3) in Korean Americans (
p
<0.01). Among those aged ≥65 years, DM prevalence was highest in Filipino (35.0% (29.4–41.2)) and Asian Indian (31.5% (25.9–37.8)) Americans. Adjusted for sex, education, and race/ethnicity-specific obesity category, NHA overall had a 21% higher DM prevalence compared to NHW (prevalence ratio 1.21 1.14–1.27), while prevalence ratios were 1.42 (1.24–1.63) in Filipinos and 1.29 (1.14–1.46) in Asian Indians.
Conclusions
Adjusted self-reported DM prevalence is higher in NHA compared with NHW. Disaggregating NHA reveals heterogeneity in self-reported DM prevalence, highest in Filipino and Asian Indian Americans.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
IMPORTANCE: Gestational diabetes is associated with adverse maternal and offspring outcomes. OBJECTIVE: To determine whether rates of gestational diabetes among individuals at first live birth ...changed from 2011 to 2019 and how these rates differ by race and ethnicity in the US. DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional analysis using National Center for Health Statistics data for 12 610 235 individuals aged 15 to 44 years with singleton first live births from 2011 to 2019 in the US. EXPOSURES: Gestational diabetes data stratified by the following race and ethnicity groups: Hispanic/Latina (including Central and South American, Cuban, Mexican, and Puerto Rican); non-Hispanic Asian/Pacific Islander (including Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese); non-Hispanic Black; and non-Hispanic White. MAIN OUTCOMES AND MEASURES: The primary outcomes were age-standardized rates of gestational diabetes (per 1000 live births) and respective mean annual percent change and rate ratios (RRs) of gestational diabetes in non-Hispanic Asian/Pacific Islander (overall and in subgroups), non-Hispanic Black, and Hispanic/Latina (overall and in subgroups) individuals relative to non-Hispanic White individuals (referent group). RESULTS: Among the 12 610 235 included individuals (mean SD age, 26.3 5.8 years), the overall age-standardized gestational diabetes rate significantly increased from 47.6 (95% CI, 47.1-48.0) to 63.5 (95% CI, 63.1-64.0) per 1000 live births from 2011 to 2019, a mean annual percent change of 3.7% (95% CI, 2.8%-4.6%) per year. Of the 12 610 235 participants, 21% were Hispanic/Latina (2019 gestational diabetes rate, 66.6 95% CI, 65.6-67.7; RR, 1.15 95% CI, 1.13-1.18), 8% were non-Hispanic Asian/Pacific Islander (2019 gestational diabetes rate, 102.7 95% CI, 100.7-104.7; RR, 1.78 95% CI, 1.74-1.82), 14% were non-Hispanic Black (2019 gestational diabetes rate, 55.7 95% CI, 54.5-57.0; RR, 0.97 95% CI, 0.94-0.99), and 56% were non-Hispanic White (2019 gestational diabetes rate, 57.7 95% CI, 57.2-58.3; referent group). Gestational diabetes rates were highest in Asian Indian participants (2019 gestational diabetes rate, 129.1 95% CI, 100.7-104.7; RR, 2.24 95% CI, 2.15-2.33). Among Hispanic/Latina participants, gestational diabetes rates were highest among Puerto Rican individuals (2019 gestational diabetes rate, 75.8 95% CI, 71.8-79.9; RR, 1.31 95% CI, 1.24-1.39). Gestational diabetes rates increased among all race and ethnicity subgroups and across all age groups. CONCLUSIONS AND RELEVANCE: Among individuals with a singleton first live birth in the US from 2011 to 2019, rates of gestational diabetes increased across all racial and ethnic subgroups. Differences in absolute gestational diabetes rates were observed across race and ethnicity subgroups.
This cross-sectional study examines the percentage of deaths attributed to ischemic heart disease by age and sex of Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese decedents.
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