Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, 375 Longwood Ave, 4th Floor, Boston, MA 02215, USA.
Meharry Medical College, Nashville, TN, USA.
Eur Heart J. 2024 Mar 27;45(12):1017-1026. doi: 10.1093/eurheartj/ehad772.
Declines in cardiovascular mortality have stagnated in the USA since 2011. There is growing concern that these patterns reflect worsening cardiovascular health in younger adults. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality has changed in this population. Changes in cardiovascular hospitalizations and mortality among adults aged 25-64 years were evaluated, overall and by community-level income.
Using the National Inpatient Sample, age-standardized annual hospitalization and in-hospital mortality rates for acute myocardial infarction (AMI), heart failure, and ischaemic stroke were determined among adults aged 25-64 years. Quasi-Poisson and quasi-binominal regression models were fitted to compare outcomes between individuals residing in low- and higher-income communities.
Between 2008 and 2019, age-standardized hospitalization rates for AMI increased among younger adults from 155.0 (95% confidence interval: 154.6, 155.4) per 100 000 to 160.7 (160.3, 161.1) per 100 000 (absolute change +5.7 [5.0, 6.3], P < .001). Heart failure hospitalizations also increased (165.3 [164.8, 165.7] to 225.3 [224.8, 225.8], absolute change +60.0 (59.3, 60.6), P < .001), as ischaemic stroke hospitalizations (76.3 [76.1, 76.7] to 108.1 [107.8, 108.5], absolute change +31.7 (31.2, 32.2), P < .001). Across all conditions, hospitalizations rates were significantly higher among younger adults residing in low-income compared with higher-income communities, and disparities did not narrow between groups. In-hospital mortality decreased for all conditions over the study period.
There was an alarming increase in cardiovascular hospitalizations among younger adults in the USA from 2008 to 2019, and disparities between those residing in low- and higher-income communities did not narrow.
自 2011 年以来，美国心血管死亡率的下降趋势已经停滞。人们越来越担心，这些模式反映了年轻人心血管健康状况的恶化。然而，人们对这一人群中急性心血管住院和死亡率的负担变化知之甚少。评估了 25-64 岁成年人的心血管住院和死亡率变化，按社区收入水平进行了总体和分类评估。
利用国家住院患者样本，确定了 25-64 岁成年人中急性心肌梗死（AMI）、心力衰竭和缺血性卒中的年龄标准化年度住院率和住院内死亡率。使用拟泊松和拟二项回归模型比较了居住在低收入和高收入社区的个体之间的结果。
2008 年至 2019 年间，年龄标准化 AMI 住院率在年轻成年人中从 155.0（95%置信区间：154.6，155.4）/100000 增加到 160.7（160.3，161.1）/100000（绝对变化+5.7[5.0，6.3]，P<0.001）。心力衰竭住院率也有所增加（165.3（164.8，165.7）至 225.3（224.8，225.8），绝对变化+60.0（59.3，60.6），P<0.001），缺血性卒中住院率也有所增加（76.3（76.1，76.7）至 108.1（107.8，108.5），绝对变化+31.7（31.2，32.2），P<0.001）。在所有情况下，与高收入社区相比，低收入社区的年轻成年人住院率显著更高，两组之间的差距并没有缩小。在研究期间，所有情况下的住院死亡率都有所下降。
2008 年至 2019 年期间，美国年轻成年人的心血管住院率惊人增加，而居住在低收入和高收入社区的人群之间的差距并未缩小。
