Trends in heart failure-related cardiovascular mortality in rural versus urban United States counties, 2011-2018: A cross-sectional study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
06
11
2020
accepted:
26
01
2021
entrez:
3
3
2021
pubmed:
4
3
2021
medline:
27
8
2021
Statut:
epublish
Résumé
Adults in rural counties in the United States (US) experience higher rates broadly of cardiovascular disease (CVD) compared with adults in urban counties. Mortality rates specifically due to heart failure (HF) have increased since 2011, but estimates of heterogeneity at the county-level in HF-related mortality have not been produced. The objectives of this study were 1) to quantify nationwide trends by rural-urban designation and 2) examine county-level factors associated with rural-urban differences in HF-related mortality rates. We queried CDC WONDER to identify HF deaths between 2011-2018 defined as CVD (I00-78) as the underlying cause of death and HF (I50) as a contributing cause of death. First, we calculated national age-adjusted mortality rates (AAMR) and examined trends stratified by rural-urban status (defined using 2013 NCHS Urban-Rural Classification Scheme), age (35-64 and 65-84 years), and race-sex subgroups per year. Second, we combined all deaths from 2011-2018 and estimated incidence rate ratios (IRR) in HF-related mortality for rural versus urban counties using multivariable negative binomial regression models with adjustment for demographic and socioeconomic characteristics, risk factor prevalence, and physician density. Between 2011-2018, 162,314 and 580,305 HF-related deaths occurred in rural and urban counties, respectively. AAMRs were consistently higher for residents in rural compared with urban counties (73.2 [95% CI: 72.2-74.2] vs. 57.2 [56.8-57.6] in 2018, respectively). The highest AAMR was observed in rural Black men (131.1 [123.3-138.9] in 2018) with greatest increases in HF-related mortality in those 35-64 years (+6.1%/year). The rural-urban IRR persisted among both younger (1.10 [1.04-1.16]) and older adults (1.04 [1.02-1.07]) after adjustment for county-level factors. Main limitations included lack of individual-level data and county dropout due to low event rates (<20). Differences in county-level factors may account for a significant amount of the observed variation in HF-related mortality between rural and urban counties. Efforts to reduce the rural-urban disparity in HF-related mortality rates will likely require diverse public health and clinical interventions targeting the underlying causes of this disparity.
Sections du résumé
BACKGROUND
Adults in rural counties in the United States (US) experience higher rates broadly of cardiovascular disease (CVD) compared with adults in urban counties. Mortality rates specifically due to heart failure (HF) have increased since 2011, but estimates of heterogeneity at the county-level in HF-related mortality have not been produced. The objectives of this study were 1) to quantify nationwide trends by rural-urban designation and 2) examine county-level factors associated with rural-urban differences in HF-related mortality rates.
METHODS AND FINDINGS
We queried CDC WONDER to identify HF deaths between 2011-2018 defined as CVD (I00-78) as the underlying cause of death and HF (I50) as a contributing cause of death. First, we calculated national age-adjusted mortality rates (AAMR) and examined trends stratified by rural-urban status (defined using 2013 NCHS Urban-Rural Classification Scheme), age (35-64 and 65-84 years), and race-sex subgroups per year. Second, we combined all deaths from 2011-2018 and estimated incidence rate ratios (IRR) in HF-related mortality for rural versus urban counties using multivariable negative binomial regression models with adjustment for demographic and socioeconomic characteristics, risk factor prevalence, and physician density. Between 2011-2018, 162,314 and 580,305 HF-related deaths occurred in rural and urban counties, respectively. AAMRs were consistently higher for residents in rural compared with urban counties (73.2 [95% CI: 72.2-74.2] vs. 57.2 [56.8-57.6] in 2018, respectively). The highest AAMR was observed in rural Black men (131.1 [123.3-138.9] in 2018) with greatest increases in HF-related mortality in those 35-64 years (+6.1%/year). The rural-urban IRR persisted among both younger (1.10 [1.04-1.16]) and older adults (1.04 [1.02-1.07]) after adjustment for county-level factors. Main limitations included lack of individual-level data and county dropout due to low event rates (<20).
CONCLUSIONS
Differences in county-level factors may account for a significant amount of the observed variation in HF-related mortality between rural and urban counties. Efforts to reduce the rural-urban disparity in HF-related mortality rates will likely require diverse public health and clinical interventions targeting the underlying causes of this disparity.
Identifiants
pubmed: 33657143
doi: 10.1371/journal.pone.0246813
pii: PONE-D-20-34927
pmc: PMC7928489
doi:
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0246813Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR001424
Pays : United States
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
JACC Heart Fail. 2020 Apr;8(4):280-288
pubmed: 32035894
Vital Health Stat 2. 2014 Apr;(166):1-73
pubmed: 24776070
JAMA. 2015 Oct 27;314(16):1731-9
pubmed: 26505597
Eur J Heart Fail. 2016 Feb;18(2):195-204
pubmed: 26817628
JAMA. 2019 Aug 27;322(8):780-782
pubmed: 31454032
PLoS One. 2020 Jul 7;15(7):e0235839
pubmed: 32634156
Health Aff (Millwood). 2019 Dec;38(12):2086-2094
pubmed: 31794309
BMJ. 2020 Aug 13;370:m2688
pubmed: 32816805
Ann Fam Med. 2020 Jul;18(4):318-325
pubmed: 32661032
J Am Coll Cardiol. 2010 Jan 26;55(4):294-9
pubmed: 20117432
Ann Epidemiol. 2017 Dec;27(12):796-800
pubmed: 29122432
Circulation. 2020 Mar 10;141(10):e615-e644
pubmed: 32078375
JAMA Cardiol. 2017 Jul 1;2(7):814-816
pubmed: 28593300
J Am Heart Assoc. 2019 Sep 17;8(18):e012422
pubmed: 31480884
N Engl J Med. 2010 Dec 9;363(24):2301-9
pubmed: 21080835
MMWR Surveill Summ. 2019 Nov 08;68(10):1-11
pubmed: 31697657
JAMA. 2011 Oct 19;306(15):1669-78
pubmed: 22009099
J Am Coll Cardiol. 2019 May 14;73(18):2354-2355
pubmed: 31072580
J Am Coll Cardiol. 2005 May 17;45(10):1654-64
pubmed: 15893183
J Am Coll Cardiol. 2002 Jan 2;39(1):83-9
pubmed: 11755291
Healthy People 2010 Stat Notes. 2001 Jan;(20):1-10
pubmed: 11676466
JAMA. 2016 Jun 7;315(21):2284-91
pubmed: 27272580
Popul Health Metr. 2014 Apr 10;12(1):10
pubmed: 24716810
JAMA Cardiol. 2019 Dec 1;4(12):1280-1286
pubmed: 31663094
Health Aff (Millwood). 2019 Dec;38(12):2003-2010
pubmed: 31794316
J Racial Ethn Health Disparities. 2016 Dec;3(4):599-607
pubmed: 27294752
Nutr Diabetes. 2018 Mar 13;8(1):14
pubmed: 29549249
Vital Health Stat 2. 2008 Oct;(148):1-23
pubmed: 19024798
Subst Abus. 2022;43(1):76-82
pubmed: 32186475
MMWR Surveill Summ. 2017 Nov 17;66(23):1-9
pubmed: 29145359
Stroke. 2019 Dec;50(12):3355-3359
pubmed: 31694505
JAMA Intern Med. 2019 Apr 1;179(4):506-514
pubmed: 30776056
Am J Cardiol. 2011 Mar 15;107(6):935-7
pubmed: 21247536
MMWR Surveill Summ. 2017 Feb 03;66(5):1-8
pubmed: 28151923
J Am Coll Cardiol. 2019 May 21;73(19):2365-2383
pubmed: 30844480
SSM Popul Health. 2018 Dec 04;7:100334
pubmed: 30581967
JAMA. 2019 Nov 26;322(20):1996-2016
pubmed: 31769830
Ann Intern Med. 1998 Dec 15;129(12):1020-6
pubmed: 9867756
Am J Public Health. 2019 Jan;109(1):155-162
pubmed: 30496008
J Investig Med. 2017 Jun;65(5):899-911
pubmed: 28330835
JACC Heart Fail. 2017 Apr;5(4):305-309
pubmed: 28359417
Popul Health Metr. 2016 Apr 28;14:14
pubmed: 27127419
Am J Prev Med. 2017 Nov;53(5):592-598
pubmed: 28688726
Health Aff (Millwood). 2018 Jan;37(1):111-120
pubmed: 29309219
J Am Coll Cardiol. 2010 Jul 27;56(5):372-8
pubmed: 20650358
JAMA Cardiol. 2016 Aug 1;1(5):594-9
pubmed: 27438477
JAMA Netw Open. 2020 Feb 5;3(2):e200241
pubmed: 32108897
Soc Sci Med. 2020 Jan;245:112689
pubmed: 31783226
JAMA Cardiol. 2019 Jul 1;4(7):671-679
pubmed: 31166575
JAMA. 2016 Jun 7;315(21):2292-9
pubmed: 27272581
Circulation. 2011 May 3;123(17):1873-80
pubmed: 21444883
Health Aff (Millwood). 2016 Aug 1;35(8):1471-9
pubmed: 27503973
BMC Cardiovasc Disord. 2017 Jul 18;17(1):192
pubmed: 28720073