Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA. 2021 Feb 2;325(5):445-453. doi: 10.1001/jama.2020.26141.
After a decline in cardiovascular mortality for nonelderly US adults, recent stagnation has occurred alongside rising income inequality. Whether this is associated with underlying economic trends is unclear.
To assess the association between changes in economic prosperity and trends in cardiovascular mortality in middle-aged US adults.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of the association between change in 7 markers of economic prosperity in 3123 US counties and county-level cardiovascular mortality among 40- to 64-year-old adults (102 660 852 individuals in 2010).
Mean rank for change in 7 markers of economic prosperity between 2 time periods (baseline: 2007-2011 and follow-up: 2012-2016). A higher mean rank indicates a greater relative increase or lower relative decrease in prosperity (range, 5 to 92; mean [SD], 50 [14]).
Mean annual percentage change (APC) in age-adjusted cardiovascular mortality rates. Generalized linear mixed-effects models were used to estimate the additional APC associated with a change in prosperity.
Among 102 660 852 residents aged 40 to 64 years living in these counties in 2010 (51% women), 979 228 cardiovascular deaths occurred between 2010 and 2017. Age-adjusted cardiovascular mortality rates did not change significantly between 2010 and 2017 in counties in the lowest tertile for change in economic prosperity (mean [SD], 114.1 [47.9] to 116.1 [52.7] deaths per 100 000 individuals; APC, 0.2% [95% CI, -0.3% to 0.7%]). Mortality decreased significantly in the intermediate tertile (mean [SD], 104.7 [38.8] to 101.9 [41.5] deaths per 100 000 individuals; APC, -0.4% [95% CI, -0.8% to -0.1%]) and highest tertile for change in prosperity (100.0 [37.9] to 95.1 [39.1] deaths per 100 000 individuals; APC, -0.5% [95% CI, -0.9% to -0.1%]). After accounting for baseline prosperity and demographic and health care-related variables, a 10-point higher mean rank for change in economic prosperity was associated with 0.4% (95% CI, 0.2% to 0.6%) additional decrease in mortality per year.
In this retrospective study of US county-level mortality data from 2010 to 2017, a relative increase in county-level economic prosperity was significantly associated with a small relative decrease in cardiovascular mortality among middle-aged adults. Individual-level inferences are limited by the ecological nature of the study.
在美国，非老年成年人的心血管死亡率下降之后，最近出现了停滞不前的情况，同时收入不平等也在加剧。目前尚不清楚这是否与潜在的经济趋势有关。
评估美国中年成年人经济繁荣变化与心血管死亡率趋势之间的关系。
设计、地点和参与者：对 3123 个美国县的 7 个经济繁荣指标的变化与 40 岁至 64 岁成年人（2010 年有 102660852 人）县一级心血管死亡率之间的关联进行回顾性分析。
两个时间段之间经济繁荣 7 个指标变化的平均等级（基线：2007-2011 年；随访：2012-2016 年）。较高的平均等级表示繁荣相对增加或相对减少（范围为 5 至 92；平均值[标准差]，50[14]）。
年龄调整后心血管死亡率的年平均百分比变化（APC）。使用广义线性混合效应模型来估计与繁荣变化相关的 APC。
在 2010 年居住在这些县的 40 岁至 64 岁的 102660852 名居民中（51%为女性），2010 年至 2017 年期间发生了 979228 例心血管死亡。在经济繁荣变化处于最低三分位数的县中，2010 年至 2017 年期间，年龄调整后的心血管死亡率没有明显变化（平均[标准差]，每 10 万人中有 114.1[47.9]至 116.1[52.7]人死亡；APC，0.2%[95%CI，-0.3%至 0.7%]）。在中间三分位数（平均[标准差]，每 10 万人中有 104.7[38.8]至 101.9[41.5]人死亡；APC，-0.4%[95%CI，-0.8%至-0.1%]）和经济繁荣变化的最高三分位数（每 10 万人中有 100.0[37.9]至 95.1[39.1]人死亡；APC，-0.5%[95%CI，-0.9%至-0.1%]）中，死亡率显著下降。在考虑基线繁荣以及人口统计学和医疗保健相关变量后，经济繁荣变化的平均等级每增加 10 分，死亡率每年额外下降 0.4%（95%CI，0.2%至 0.6%）。
在这项对 2010 年至 2017 年美国县一级死亡率数据的回顾性研究中，县一级经济繁荣的相对增加与中年成年人心血管死亡率的相对下降显著相关。个体水平的推论受到研究的生态性质的限制。
