Clinical InvestigationsEpidemiologic trends and risk factors associated with the decline in mortality from coronary heart disease in the United States, 1990-2019
Graphical Abstract
Section snippets
Study design and data source
We undertook a sequential time series analysis to examine temporal changes in mortality rates from CHD in the US between 1990 and 2019. We ascertained data on all deaths that occurred in the US as compiled and deidentified by the National Center for Health Statistics of the US Centers for Disease Control and Prevention. We ascertained data from the Survey of Epidemiology and End Results on annual mid-year population counts by age and sex between 1990 and 2019.18 Since all data used is publicly
Results
The number of CHD deaths as the underlying cause between 1990 and 2019 was 3,452,043 among females and 5,572,629 among males aged 25 to 84 years. The overall CHD mortality rate declined from 124.4 (95% confidence interval [CI] 123.8, 125.0) in 1990 to 42.7 (95% CI 42.4, 42.9) per 100,000 in 2019. Among females, the age-adjusted CHD mortality rate declined from 210.5 in 1990 to 66.8 per 100,000 in 2019; among males, the corresponding rates dropped from 442.4 in 1990 to 156.7 per 100,000 (Table I
Principal findings
Based on a large population-based study of CHD trends in the US over 3 decades, we show 68% and 64% declines in CHD mortality among females and males, respectively. We also found that the rate of CHD mortality decline has slowed since 2010, which was especially notable among younger birth cohorts and is an observation that warrants further attention. Additionally, we found that secular changes in rates of alcohol use, tobacco smoking, and high BMI are strongly associated with these trends,
Conclusions
Mortality rates from CHD have declined substantially in the US over the last 3 decades. These declines have occurred concurrently with similar declines in deaths from chronic ischemic heart disease, acute myocardial infarction, and atherosclerotic heart disease. This study underscores substantial reductions in the number of CHD deaths in the US that are attributable to changes in smoking, alcohol, and high BMI. Further reductions in CHD mortality may be achieved through an intentional campaign
Disclosures
None reported.
Funding
Drs. Ananth and Kostis and Ms. Graham are supported, in part, by the National Heart, Lung, and Blood Institute (grant R01-HL150065). Dr. Ananth is additionally supported, in part, by the National Institute of Environmental Health Sciences (grant R01-ES033190).
Data Availability Statement
Mortality data utilized in this study can be accessed from the Centers for Disease Control and Prevention (http://www.cdc.gov/) and the population counts from the Survey of Epidemiology and End Results, NIH (https://seer.cancer.gov/popdata/download.html).
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