In 2014, cardiovascular diseases accounted for the leading cause of death in 97.1 percent of counties in the U.S. and the leading age-standardized cause of death in 98.5 percent of counties, according to an analysis of deidentified death records.
However, the rate of death from cardiovascular diseases varied considerably from county to county. For instance, the rate for the 10th percentile of counties was 209.2 deaths per 100,000 population, while the rate for the 90th percentile of counties was 356.2 deaths per 100,000 population.
Lead researcher Laura Dwyer-Lindgren, MPH, of the Institute for Health Metrics and Evaluation at the University of Washington, and colleagues published their results online in JAMA on Dec. 13.
The analysis included death records from the National Vital Statistics System that occurred within the U.S. from 1980 through 2014. The records contained information on the age, sex, and county of residence at the time of death for each decedent as well as the underlying cause of death.
The researchers also developed a model that took several county-level factors into consideration, including levels of education, income, race/ethnicity, Native American reservations and population density. In addition, they used garbage code redistribution methods to reassign deaths that were classified as non-specific or had an implausible cause of death. In all, they examined 21 causes of death.
From 1980 through 2014, cardiovascular diseases caused 31,992,547 deaths, which accounted for 39.8 percent of all deaths during that period.
In 2014, cardiovascular diseases accounted for the leading cause of death in the U.S. with 846,300 death, the leading mortality rate with 252.7 deaths per 100,000 population and the second most years of life lost. The mortality rates for cardiovascular diseases within counties ranged from 77.0 deaths per 100,000 population to 545.2 deaths per 100,000 population. The median mortality rate was 272.3 deaths per 100,000 population.
The highest mortality rates for cardiovascular diseases in 2014 occurred in counties stretching from Oklahoma to Mississippi and in eastern Kentucky, while the lowest rates occurred in Colorado and near the borders of Idaho, Montana and Wyoming.
Although cardiovascular disease mortality decreased by 50.2 percent in the U.S. between 1980 and 2014, the rate of decline varied considerably within geographic regions. The slowest rates of improvement were found in counties in states from Oklahoma to Alabama and Kentucky.
The researchers acknowledged a few limitations of the study, including that they did not have information on deaths of U.S. residents that occurred outside the country. They also mentioned that the covariates used in their models and the population counts could be subject to error. In addition, the garbage code redistribution methods they used were not validated and might also be subject to error.
“In this analysis of U.S. cause-specific county-level mortality rates from 1980 through 2014, there were large between-county differences for every cause of death, although geographic patterns varied substantially by cause of death,” the researchers wrote. “The approach to county-level analyses with small area models used in this study has the potential to provide novel insights into U.S. disease-specific mortality time trends and their differences across geographic regions.”
Executive Editor
Tim Casey joined TriMed Media Group in 2015 as Executive Editor. For the previous four years, he worked as an editor and writer for HMP Communications, primarily focused on covering managed care issues and reporting from medical and health care conferences. He was also a staff reporter at the Sacramento Bee for more than four years covering professional, college and high school sports. He earned his undergraduate degree in psychology from the University of Notre Dame and his MBA degree from Georgetown University.