Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL.
Department of Epidemiology, Human Genetics, and Environmental Sciences School of Public Health University of Texas Health Science Center Dallas TX.
J Am Heart Assoc. 2021 May 4;10(9):e020541. doi: 10.1161/JAHA.120.020541. Epub 2021 Apr 23.
Background Cardiovascular disease mortality related to heart failure (HF) is rising in the United States. It is unknown whether trends in HF mortality are consistent across geographic areas and are associated with state-level variation in cardiovascular health (CVH). The goal of the present study was to assess regional and state-level trends in cardiovascular disease mortality related to HF and their association with variation in state-level CVH. Methods and Results Age-adjusted mortality rates (AAMR) per 100 000 attributable to HF were ascertained using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research from 1999 to 2017. CVH at the state-level was quantified using the Behavioral Risk Factor Surveillance System. Linear regression was used to assess temporal trends in HF AAMR were examined by census region and state and to examine the association between state-level CVH and HF AAMR. AAMR attributable to HF declined from 1999 to 2011 and increased between 2011 and 2017 across all census regions. Annual increases after 2011 were greatest in the Midwest (β=1.14 [95% CI, 0.75, 1.53]) and South (β=0.96 [0.66, 1.26]). States in the South and Midwest consistently had the highest HF AAMR in all time periods, with Mississippi having the highest AAMR (109.6 [104.5, 114.6] in 2017). Within race‒sex groups, consistent geographic patterns were observed. The variability in HF AAMR was associated with state-level CVH (<0.001). Conclusions Wide geographic variation exists in HF mortality, with the highest rates and greatest recent increases observed in the South and Midwest. Higher levels of poor CVH in these states suggest the potential for interventions to promote CVH and reduce the burden of HF.
在美国，与心力衰竭（HF）相关的心血管疾病死亡率正在上升。尚不清楚 HF 死亡率的趋势是否在各个地理区域一致，以及是否与心血管健康（CVH）的州级差异有关。本研究的目的是评估与 HF 相关的心血管疾病死亡率的区域和州级趋势及其与州级 CVH 变化的相关性。
使用疾病控制与预防中心的广域在线流行病学研究数据，从 1999 年到 2017 年，确定归因于 HF 的每 100000 人年龄调整死亡率（AAMR）。使用行为危险因素监测系统量化州级 CVH。线性回归用于评估 HF AAMR 的时间趋势，按普查区域和州进行检查，并检查州级 CVH 与 HF AAMR 之间的关系。在所有普查区域，HF 的 AAMR 从 1999 年到 2011 年下降，在 2011 年到 2017 年之间增加。2011 年之后，中西部（β=1.14[95%CI，0.75，1.53]）和南部（β=0.96[0.66，1.26]）的年增长率最高。在所有时期，南部和中西部各州的 HF AAMR 始终最高，密西西比州的 AAMR 最高（2017 年为 109.6[104.5，114.6]）。在种族-性别群体中，观察到一致的地理模式。HF AAMR 的变异性与州级 CVH 相关（<0.001）。
HF 死亡率存在广泛的地理差异，南部和中西部的死亡率最高，最近的增长率也最高。这些州 CVH 水平较差，表明有可能采取干预措施促进 CVH 并减轻 HF 的负担。
