Ali Eman, Mashkoor Yusra, Latif Fakhar, Zafrullah Fnu, Alruwaili Waleed, Nassar Sameh, Gonuguntla Karthik, Thyagaturu Harshith, Kawsara Mohammad, Daggubati Ramesh, Sattar Yasar, Asghar Muhammad Sohaib
Dow University of Health Sciences, Karachi, Pakistan.
Department of Cardiology, Ascension Borgess Hospital/Michigan State University, MI, USA.
Int J Cardiol Cardiovasc Risk Prev. 2024 Aug 17;22:200321. doi: 10.1016/j.ijcrp.2024.200321. eCollection 2024 Sep.
BACKGROUND: Valvular heart disease (VHD) represents a spectrum of cardiac conditions, including valvular stenosis, valvular regurgitation, or mixed lesions affecting single or multiple valves. The severity of VHD has emerged as a major cause of cardiovascular (CV) morbidity and mortality among the older population in the United States (U.S). OBJECTIVE: To evaluate temporal trends in mortality associated with VHD in the elderly U.S population between 1999 and 2019. METHODS: We utilized the CDC WONDER database for VHD mortality in adults ≥75 from 1999 to 2019, using ICD-10 codes. Age-adjusted mortality rates (AAMR) per 100,000 people with associated annual percentage change (APC) were calculated. Joinpoint regression was used to assess the overall trends and trends for demographic, geographic, and type of valvular disease subgroups. RESULTS: A total of 666,765 VHD deaths in older adults from 1999 to 2019 was identified, with an initial decline in AAMR until 2007 with an APC: 0.62, 95 % CI (-1.66-0.33), stability until 2014, and a significant decrease until 2019 (APC: 1.47, 95 % CI [-2.24-1.04], P < 0.0001). Men consistently had higher AAMRs compared to women (overall AAMR men: 173.6; women: 138.2). The AAMRs were found to be highest in the White (166.5), followed by American Indian or Alaska Native population at (93.8) Hispanic or Latino at (80.7), Black or African American populations at (74.1) and lastly Asian or Pacific Islander (73.4). Non-metropolitan areas manifested higher AAMRs for deaths related to VHD than metropolitan areas (overall AAMRs 160.5 vs 149.5) respectively. State-wide AAMRs varied, with the highest in Vermont at 324.2 (95 % CI [313.0-335.4], P < 0.0001) and the lowest in Mississippi at 88.0 (95 % CI [85.0-91.0], P < 0.0001). Non-rheumatic and aortic valve disorders in adults ≥75 years had higher mortality rates compared to rheumatic or mitral valve conditions in those <75 years. CONCLUSION: Our study showed a decline in U.S. VHD mortality from 1999 to 2019 but found persistent disparities by gender, race, age, region, and VHD type. Targeted policies for prevention and early diagnosis are needed to address these inequalities.
背景：心脏瓣膜病（VHD）涵盖一系列心脏疾病，包括瓣膜狭窄、瓣膜反流或影响单个或多个瓣膜的混合性病变。在美国老年人群中，VHD的严重程度已成为心血管（CV）发病和死亡的主要原因。 目的：评估1999年至2019年美国老年人群中与VHD相关的死亡率的时间趋势。 方法：我们利用疾病控制与预防中心（CDC）的WONDER数据库，通过国际疾病分类第十版（ICD - 10）编码，获取1999年至2019年≥75岁成年人的VHD死亡率。计算每10万人的年龄调整死亡率（AAMR）及相关的年度百分比变化（APC）。采用连接点回归分析总体趋势以及按人口统计学、地理区域和瓣膜病亚组类型划分的趋势。 结果：1999年至2019年共确定了666,765例老年成年人的VHD死亡病例。AAMR最初呈下降趋势，直至2007年（APC：0.62，95%置信区间[-1.66 - 0.33]），2014年前保持稳定，2019年显著下降（APC：1.47，95%置信区间[-2.24 - 1.04]，P < 0.0001）。男性的AAMR始终高于女性（总体AAMR男性：173.6；女性：138.2）。发现白人的AAMR最高（166.5），其次是美洲印第安人或阿拉斯加原住民（93.8）、西班牙裔或拉丁裔（80.7）、黑人或非裔美国人（74.1），最后是亚裔或太平洋岛民（73.4）。非大都市地区与VHD相关的死亡AAMR高于大都市地区（总体AAMR分别为160.5和149.5）。各州的AAMR各不相同，佛蒙特州最高，为324.2（95%置信区间[313.0 - 335.4]，P < 0.0001），密西西比州最低，为88.0（95%置信区间[85.0 - 91.0]，P < 0.0001）。≥75岁成年人的非风湿性和主动脉瓣疾病的死亡率高于<75岁人群的风湿性或二尖瓣疾病。 结论：我们的研究表明，1999年至2019年美国VHD死亡率呈下降趋势，但发现性别、种族、年龄、地区和VHD类型方面存在持续差异。需要制定有针对性的预防和早期诊断政策来解决这些不平等问题。
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