加利福尼亚州心血管疾病死亡率趋势：性别-种族/族裔差异和收入不平等。

Trends in California Cardiovascular Disease Mortality: Sex-Race/Ethnicity Disparity and Income Inequality.

机构信息

Chronic Disease Control Branch, Center for Healthy Communities, California Department of Public Health, Sacramento.

Department of Medicine, University of California, Davis and Sacramento.

出版信息

Mayo Clin Proc. 2024 Nov;99(11):1756-1770. doi: 10.1016/j.mayocp.2024.02.018. Epub 2024 May 13.

DOI:10.1016/j.mayocp.2024.02.018

PMID:38739073

Abstract

OBJECTIVE

To examine the cardiovascular disease (CVD)-related death trends and the relationship between CVD deaths and sex, race/ethnicity, and income in California from January 1, 1999, to December 31, 2021.

METHODS

The age-adjusted death rate (AADR) per 100,000 population attributable to ischemic heart disease (IHD), hypertensive heart disease (HHD) and heart failure (HF), stroke, and CVD combined were calculated using CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) for California, 1999 to 2021. We used a joinpoint log-linear regression model to determine trends in CVD death. Income disparities were assessed using the slope index of inequality and health concentration index.

RESULTS

Between 1999 and 2021, overall death rates for CVD decreased significantly (average annual percent change, -2.2% [95% confidence interval: -2.6%, -1.7%]), IHD (-3.7% [-4.3%, -3.1%]), and stroke (-2.0% [-2.8%, -1.2%]) and increased for HHD (2.0% [0.6%, 3.5%]) and HF (2.0% [1.3%, 2.7%]). The AADR of combined CVD first decreased significantly (1999-2014; all P<.001), then increased significantly after COVID-19 (P=.02). The AADR of IHD decreased significantly (1999-2019; all P<.001) and then increased after the COVID-19 pandemic but was not statistically significant (P=.15). The AADR of HHD (2014-2021) and HF (2013-2021) increased significantly (all P<.001), and this increase accelerated after COVID-19. The AADR of stroke decreased (1999-2009), then increased after COVID-19 but was not statistically significant (P=.07). Our results revealed significant disparities with CVD death being disproportionately higher among male, non-Hispanic Black, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, Asian, and poorer populations.

CONCLUSION

All the death rates that were decreasing, stagnant, or increasing prior to the COVID-19 pandemic increased after the pandemic. We found increasingly adverse outcomes among the poor and racial/ethnic minority populations.

摘要

目的

从 1999 年 1 月 1 日至 2021 年 12 月 31 日，研究加利福尼亚州与心血管疾病（CVD）相关的死亡趋势，以及 CVD 死亡与性别、种族/民族和收入之间的关系。

方法

使用疾病预防控制中心的广域在线数据进行流行病学研究（CDC WONDER）计算归因于缺血性心脏病（IHD）、高血压性心脏病（HHD）和心力衰竭（HF）、中风以及 CVD 合并的每 100,000 人年龄调整死亡率（AADR），1999 年至 2021 年加利福尼亚州。我们使用连接点对数线性回归模型来确定 CVD 死亡趋势。使用不平等斜率指数和健康集中指数评估收入差距。

结果

1999 年至 2021 年间，CVD 总死亡率显著下降（平均年变化百分比，-2.2%[95%置信区间：-2.6%，-1.7%]），IHD（-3.7%[-4.3%，-3.1%]）和中风（-2.0%[-2.8%，-1.2%]）而 HHD（2.0%[0.6%，3.5%]）和 HF（2.0%[1.3%，2.7%]）则增加。CVD 合并的 AADR 最初显著下降（1999-2014 年；均<.001），然后在 COVID-19 后显著增加（P=.02）。IHD 的 AADR 显著下降（1999-2019 年；均<.001），然后在 COVID-19 大流行后增加，但无统计学意义（P=.15）。HHD（2014-2021 年）和 HF（2013-2021 年）的 AADR 显著增加（均<.001），并且 COVID-19 后这一增长加速。中风的 AADR 下降（1999-2009 年），然后在 COVID-19 后增加，但无统计学意义（P=.07）。我们的结果显示，CVD 死亡存在显著差异，男性、非西班牙裔黑人、美洲印第安人或阿拉斯加原住民、夏威夷原住民或太平洋岛民、亚洲人和贫困人口的死亡率较高。