Decline in CHD prevalence slows in US
CDC data show an overall decline in the prevalence of self-reported CHD in the U.S. slowed during the past decade, likely due to trends in risk factors such as obesity, type 2 diabetes, high sodium intake and hypertension.
“The national change in CHD prevalence from 2011 to 2018 was not significant,” Cathleen Gillespie, MS, a senior statistician in the division for heart disease and stroke prevention at the CDC, and colleagues wrote in a research letter published in JAMA Cardiology. “Statistically significant, albeit modest, declines and increases were observed for some sociodemographic groups and states. Variations in CHD prevalence in 2018 were observed by sociodemographic group and state.”
Heart disease is the leading cause of death in the U.S. and CHD accounts for the largest proportion of deaths, according to the American Heart Association. A deceleration in declining CHD death rates began in 2011.
To evaluate recent trends in self-reported CHD prevalence, Gillespie and colleagues analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 to 2018, including data from 3,572,977 adults who completed a telephone survey. Participants who responded yes to either “Has a doctor, nurse, or other health professional ever told you that you had angina or coronary heart disease?” or “Has a doctor, nurse, or other health professional ever told you that you had a heart attack, also called a myocardial infarction?” were defined as having self-reported CHD. Researchers assessed CHD prevalence by age, sex, race, education, household income and health insurance coverage. Annual prevalence estimates were age-standardized to the 2000 U.S. standard population, and trends were examined by sociodemographic characteristic and state.
From 2011 to 2018, the change in CHD prevalence was statistically insignificant, declining from 6.2% to 6%, for an absolute change of 0.11% (95% CI, 0.3 to 0.1; P = .22).
Stratified by state, researchers observed a decrease in CHD prevalence for Utah, with an absolute change of 1.09% (95% CI, 1.71 to 0.46; P < .001), and slight declines in prevalence that did not reach significance for California, Nebraska and Washington, D.C. CHD prevalence rose during the past decade in Oregon and West Virginia.
Adults aged at least 65 years and college graduates experienced small but statistically significant decreases in CHD, with an absolute change of 1.82% (95% CI, 2.4 to 1.2; P < .001) and 0.35% (95% CI, 0.6 to 0.1; P = .002) respectively.
Adults aged 18 to 44 years had a small but statistically significant increase, with an absolute change of 0.34% (95% CI, 0.2-0.5; P < .001).
In 2018, CHD prevalence was greater among men (7.7%) than women (4.6%); researchers also observed differences in CHD prevalence by age, race/ethnicity, education and income. No significant differences were noted by health insurance coverage. Among states, CHD prevalence ranged from 4% in Washington, D.C., to 10.6% in West Virginia.
A previous study of CHD trends using BRFSS data reported a decrease in prevalence from 6.7% in 2006 to 6% in 2010; however, the addition of cellular phones and changes in BRFSS methodology inhibit direct comparisons with earlier BRFSS results.
“Although results cannot be directly compared because of changes in the BRFSS sampling frame, declines in CHD prevalence may be slowing,” the researchers wrote. “Trends in risk factors such as obesity, type 2 diabetes, high sodium intake and hypertension may have important implications for the trajectories of CHD prevalence and mortality.”
The researchers noted other factors not examined in this study could affect risk factors and CHD, including Medicaid expansion and differences in social determinants of health.
“The modest declines in CHD prevalence may be influenced by trends in risk factors, including obesity and type 2 diabetes,” the researchers wrote. “Findings highlight the need for rigorous broad-scale CHD preventive and management efforts.”