Kent State University Kent OH USA.
University Hospitals Cleveland OH USA.
J Am Heart Assoc. 2023 Oct 17;12(20):e030290. doi: 10.1161/JAHA.123.030290. Epub 2023 Oct 7.
Background Although cardiovascular mortality (CVM) rates in the United States have been declining overall, our study evaluated whether this holds true for areas with increased social deprivation. Methods and Results We used county-level cross-sectional age-adjusted CVM rates (aa-CVM) (2000-2019) linked to the Centers for Disease Control and Prevention Social Vulnerability Index (SVI-2010). We grouped counties as per SVI (Groups I 0-0.2, II 0.21-0.4, III 0.41-0.6, IV 0.61-0.8, and V 0.81-1) and calculated the relative change in the aa-CVM between 2000 to 2003 and 2016 to 2019. We used adjusted linear regression analyses to explore the association between a higher SVI and temporal aa-CVM improvement; we studied this temporal change in aa-CVM across subgroups of race, sex, and location. The median aa-CVM rate (per 100 000) was 272.6 (interquartile range [IQR]: 237.5-311.7). The aa-CVM was higher in men (315.6 [IQR: 273.4-363.9]) than women (221.3 [IQR: 189.6-256.7]), and in Black residents (347.2 [IQR: 301.1-391.1]; <0.001) than White residents (258.9 [IQR: 226-299.1]; <0.001). The aa-CVM for SVI I (233.6 [IQR: 214.8-257.0]) was significantly lower than that of group V (323.6 [IQR: 277.2-359.2]; <0.001). The relative reduction in CVM was significantly higher for SVI group I (32.2% [IQR: 24.2-38.4]) than group V (27.2% [IQR: 19-34.1]) counties. After multivariable adjustment, a higher SVI index was associated with lower relative improvement in the age-adjusted CVM (model coefficient -3.11 [95% CI, -5.66 to -1.22]; <0.001). Conclusions Socially deprived counties in the United States had higher aa-CVM rates, and the improvement in aa-CVM over the past 20 years was lower in these counties.
尽管美国的心血管死亡率（CVM）总体呈下降趋势，但我们的研究评估了在社会剥夺程度增加的地区是否存在这种情况。
我们使用县一级的年龄调整心血管死亡率（aa-CVM）（2000-2019 年）与疾病控制与预防中心社会脆弱性指数（SVI-2010）相关联。我们根据 SVI 将县分为五组（I 组 0-0.2、II 组 0.21-0.4、III 组 0.41-0.6、IV 组 0.61-0.8 和 V 组 0.81-1），并计算 2000 年至 2003 年与 2016 年至 2019 年之间的 aa-CVM 的相对变化。我们使用调整后的线性回归分析来探讨更高的 SVI 与时间调整的 CVM 改善之间的关联；我们研究了种族、性别和位置亚组中这种时间调整的 aa-CVM 变化。中位数 aa-CVM 率（每 100000 人）为 272.6（四分位距 [IQR]：237.5-311.7）。男性（315.6 [IQR：273.4-363.9]）的 aa-CVM 高于女性（221.3 [IQR：189.6-256.7]），黑人居民（347.2 [IQR：301.1-391.1]；<0.001）高于白人居民（258.9 [IQR：226-299.1]；<0.001）。SVI I 组（233.6 [IQR：214.8-257.0]）的 aa-CVM 明显低于 V 组（323.6 [IQR：277.2-359.2]；<0.001）。SVI 组 I（32.2% [IQR：24.2-38.4]）的 CVM 相对减少率明显高于 V 组（27.2% [IQR：19-34.1]）。在多变量调整后，较高的 SVI 指数与年龄调整的 CVM 相对改善较低相关（模型系数-3.11 [95%CI，-5.66 至-1.22]；<0.001）。
美国社会资源匮乏的县的 aa-CVM 率较高，在过去 20 年中，这些县的 aa-CVM 改善幅度较低。
