Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, Ill.
Department of Medicine (General Internal Medicine and Geriatrics), Northwestern University Feinberg School of Medicine, Chicago, Ill.
Am J Med. 2024 Jun;137(6):509-514.e2. doi: 10.1016/j.amjmed.2024.02.021. Epub 2024 Feb 22.
Although cardiovascular disease mortality rates in the United States declined from the 1970s to 2010s, they have now plateaued. The independent effects of age, period, and birth year (cohort) on cardiovascular disease mortality have not previously been defined.
We used data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research to examine the effects of age, period, and cohort on cardiovascular disease mortality among individuals aged 20-84 years from 1999 to 2018, prior to the onset of the coronavirus disease 2019 pandemic. Age effects were described as cardiovascular disease-related mortality rates in each 5-year age group adjusted for year of death (period) and year of birth (cohort). Period and cohort effects were quantified as adjusted rate ratios (RRs) comparing cardiovascular disease mortality rates in each period and cohort to the reference periods and reference cohort (ie, 1919 birth cohort), respectively.
Between 1999 to 2018, there were 10,404,327 cardiovascular disease deaths among US adults. In each individual birth cohort, the age-specific cardiovascular disease mortality rates were stable between ages 20 through 39 years. Age-specific rates were higher for each year older between ages 40 through 84 years adjusting for period effects. The period cardiovascular disease mortality rates were lower in later periods (2004-2008 period RR 0.87, 95% confidence interval [CI] 0.85 to 0.88; 2009-2013 period RR 0.78, 95% CI 0.76 to 0.80) compared with the reference period (1999 to 2003) and plateaued thereafter. The cohort cardiovascular disease mortality rates were progressively lower in more recent birth cohorts (1924 birth cohort RR 0.85, 95% CI 0.83 to 0.87; 1974 birth cohort RR 0.29, 95% CI 0.27 to 0.32) compared with the reference cohort (1919 cohort) and plateaued thereafter.
Although cardiovascular disease mortality rates declined rapidly among those born between 1919 and 1974, improvements plateaued in birth cohorts thereafter even adjusted for period effects.
尽管美国心血管疾病死亡率从 20 世纪 70 年代到 2010 年代有所下降，但现在已经趋于平稳。年龄、时期和出生年份（队列）对心血管疾病死亡率的独立影响以前尚未确定。
我们使用疾病控制与预防中心的广泛在线流行病学研究数据，检查了 1999 年至 2018 年期间，20-84 岁人群中年龄、时期和队列对心血管疾病死亡率的影响，在此之前，新冠病毒 2019 大流行尚未发生。年龄效应被描述为每个 5 年年龄组中与心血管疾病相关的死亡率，根据死亡年份（时期）和出生年份（队列）进行调整。时期和队列效应被量化为调整后的比率（RR），将每个时期和队列的心血管疾病死亡率与参考时期和参考队列（即 1919 年出生队列）进行比较。
在 1999 年至 2018 年期间，美国成年人中有 10404327 人死于心血管疾病。在每个个体出生队列中，20 至 39 岁之间的年龄特异性心血管疾病死亡率保持稳定。在调整了时期效应后，40 至 84 岁之间的每个年龄都有更高的年龄特异性死亡率。与参考时期（1999 年至 2003 年）相比，后期时期的心血管疾病死亡率（2004-2008 年时期 RR 0.87，95%置信区间 [CI] 0.85 至 0.88；2009-2013 年时期 RR 0.78，95% CI 0.76 至 0.80）较低，此后趋于平稳。与参考队列（1919 年队列）相比，最近的出生队列的队列心血管疾病死亡率（1924 年队列 RR 0.85，95% CI 0.83 至 0.87；1974 年队列 RR 0.29，95% CI 0.27 至 0.32）逐渐降低，此后趋于平稳。
尽管出生于 1919 年至 1974 年之间的人群的心血管疾病死亡率迅速下降，但即使考虑了时期效应，此后出生队列的改善也趋于平稳。
