Disclosures: The authors report no relevant financial disclosures.
July 29, 2020
3 min read

Disparities may be slowing improvements in premature cardiac death

Disclosures: The authors report no relevant financial disclosures.
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In the U.S. since 2010, the overall decline in premature cardiac death slowed, but there were significant state-to-state, socioeconomic and demographic differences, researchers reported.

Researchers in China utilized U.S. mortality data to identify county-wide disparities in premature cardiac death and also investigated state-level factors associated with the disparities.

Someone clutching heart
Source: Adobe Stock.

“We observed the somewhat uprising trend in CVD mortality in young adults about 15 years ago and unfortunately this trend has been persistent over the time,” Zhi-Jie Zheng, MD, PhD, professor and chair in the department of global health at Peking University in Beijing, told Healio. “The slower rate of decline and widening disparities in country-level CVD mortality indicate that continued and sustainable efforts are needed, particularly the primary prevention and risk reduction and timely management of acute events so patients can get timely diagnosis and treatment.”

For the study, published in the Journal of the American Heart Association, researchers defined premature cardiac death as any death of an individual aged 35 to 74 years with an underlying cause of death from CVD.

Geographical changes over time

Among individuals aged 35 to 74 years, 1,598,173 CVD deaths occurred in the U.S. from 1999 to 2017 (age-standardized rate, 55.2 per 100,000 person-years), of which 60.9% occurred out of hospital.

Researchers found that from 1999 to 2010, premature cardiac death decreased by 3.51 deaths per 100,000 individuals annually (95% CI, 3.97 to 3.05; P < .01), but from 2010 to 2017, the annual rate of decline slowed to 0.75 per 100,000 individuals (95% CI, 0.97 to 0.52; P < .01).

The age-adjusted prevalence of premature cardiac death was twofold for men compared with women (77.3 per 100,000 person-years vs. 34.9 per 100,000 person-years), and more than three times greater among Black individuals compared with those who were Asian or Pacific Islander (81.8 per 100,000 person-years vs. 23 per 100,000 person-years).

Additionally, premature cardiac death increased with age, with rates among individuals aged 65 to 74 years approximately 15.3 times greater than those aged 35 to 44 years, according to the researchers.

Moreover, the Theil index, which can break down disparities into within- and between-state factors, increased from 0.1 in 1999 to 0.23 in 2017. Geographically, within-state differences accounted for much of the disparity (57.4% in 2017), according to the study.

“CVD remains the leading cause of death for Americans,” Zheng said in an interview. “While public health and clinical interventions have significantly reduced the death rates for the U.S. population over the time, individuals must take first responsibility to his or her own health through healthy lifestyle and behaviors and reducing risks for having a disease.”


Factors associated with disparities

In other findings, the overall prevalence of premature cardiac death declined in every state from 1999 to 2017, but changes from 2010 to 2017 were smaller, and states such as South Dakota, for example, experienced a 27.8% increase in its death rate compared with a 47.9% decrease from 1999 to 2010.

Researchers observed that the demographic composition regions (socioeconomic factors; health care environment; population health status) were associated with similar level of disparity for out-of-hospital and in-hospital premature cardiac death (36.51% for out-of-hospital vs. 37.51% for in-hospital).

For every 1-point increase in the population density of certain ethnicities, the prevalence of premature cardiac death was also affected:

  • For Black residents, mortality increased by 0.078 per 100,000 person-years (95% CI, 0.03-0.125).
  • For Asian residents, mortality increased by 0.605 per 100,000 person-years (95% CI, 0.403-0.807).
  • For foreign-born residents, mortality was lowered by 0.253 per 100,000 person-years (95% CI, 0.422 to 0.084).

Moreover, for every $1,000 increase in median household income, risk for premature cardiac death decreased by 0.19 per 100,000 person-years (95% CI, 0.25 to 0.13).

“Pediatricians should start lifestyle interventions as early as possible to help children and adolescence to adhere a heart-healthy lifestyle including balanced nutrition and routine physical exercise,” Zheng told Healio. “Cardiologists should pay special attention to younger patients with high risks such as overweight and obesity and high blood pressure and be aware of younger patients with a potential of heart attack or other cardiac problems. Public health intervention programs should also target the school setting.”