Ibrahim Ramzi, Shahid Mahek, Tan Min-Choon, Martyn Trejeeve, Lee Justin Z, William Preethi
Department of Medicine, University of Arizona Tucson, Tucson, Arizona.
Department of Medicine, University of Arizona Tucson, Tucson, Arizona.
Am J Cardiol. 2023 Dec 15;209:42-51. doi: 10.1016/j.amjcard.2023.09.087. Epub 2023 Oct 16.
Heart failure (HF) remains a significant cause of morbidity and mortality in women. Population-level analyses shed light on existing disparities and promote targeted interventions. We evaluated HF-related mortality data in women in the United States to identify disparities based on race/ethnicity, urbanization level, and geographic region. We conducted a retrospective cohort analysis utilizing the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database to identify HF-related mortality in the death files from 1999 to 2020. Age-adjusted HF mortality rates were standardized to the 2000 US population. We fit log-linear regression models to analyze mortality trends. Age-adjusted HF mortality rates in women have decreased significantly over time, from 97.95 in 1999 to 89.19 in 2020. Mortality mainly downtrended from 1999 to 2012, followed by a significant increase from 2012 to 2020. Our findings revealed disparities in mortality rates based on race and ethnicity, with the most affected population being non-Hispanic Black (age-adjusted mortality rates [AAMR] 90.36), followed by non-Hispanic White (AAMR 83.25), American Indian/Alaska Native (AAMR 64.27), and Asian/Pacific Islander populations (AAMR 37.46). We also observed that nonmetropolitan (AAMR 103.36) and Midwestern (AAMR 90.45) regions had higher age-adjusted mortality rates compared with metropolitan (AAMR 78.43) regions and other US census regions. In conclusion, significant differences in HF mortality rates were observed based on race/ethnicity, urbanization level, and geographic region. Disparities in HF outcomes persist and efforts to reduce HF-related mortality rates should focus on targeted interventions that address social determinants of health, including access to care and socioeconomic status.
心力衰竭（HF）仍是女性发病和死亡的重要原因。基于人群层面的分析揭示了现存的差异，并推动了针对性干预措施的实施。我们评估了美国女性与HF相关的死亡率数据，以确定基于种族/族裔、城市化水平和地理区域的差异。我们利用疾病控制和预防中心的广泛在线流行病学研究数据库进行了一项回顾性队列分析，以确定1999年至2020年死亡档案中与HF相关的死亡率。年龄调整后的HF死亡率按照2000年美国人口进行标准化。我们拟合对数线性回归模型来分析死亡率趋势。随着时间的推移，女性年龄调整后的HF死亡率显著下降，从1999年的97.95降至2020年的89.19。死亡率主要在1999年至2012年呈下降趋势，随后在2012年至2020年显著上升。我们的研究结果揭示了基于种族和族裔的死亡率差异，受影响最大的人群是非西班牙裔黑人（年龄调整死亡率[AAMR]为90.36），其次是非西班牙裔白人（AAMR为83.25）、美国印第安人/阿拉斯加原住民（AAMR为64.27）以及亚裔/太平洋岛民群体（AAMR为37.46）。我们还观察到，与大都市地区（AAMR为78.43）和美国其他人口普查地区相比，非大都市地区（AAMR为103.36）和中西部地区（AAMR为90.45）的年龄调整死亡率更高。总之，基于种族/族裔、城市化水平和地理区域，观察到HF死亡率存在显著差异。HF结局的差异依然存在，降低与HF相关死亡率的努力应侧重于针对解决健康的社会决定因素的针对性干预措施，包括获得医疗服务的机会和社会经济地位。
