Comparative Trends in Heart Disease, Stroke, and All-Cause Mortality in the United States and a Large Integrated Healthcare Delivery System - 18/06/18
, Michael E. Sorel, MPH a, Charles P. Quesenberry, PhD a, Marc G. Jaffe, MD b, Matthew D. Solomon, MD, PhD a, c, Mai N. Nguyen-Huynh, MD d, Alan S. Go, MD a, e, f, Jamal S. Rana, MD, PhD a, c, gAbstract |
Objectives |
Heart disease and stroke remain among the leading causes of death nationally. We examined whether differences in recent trends in heart disease, stroke, and total mortality exist in the United States and Kaiser Permanente Northern California (KPNC), a large integrated healthcare delivery system.
Methods |
The main outcome measures were comparisons of US and KPNC total, age-specific, and sex-specific changes from 2000 to 2015 in mortality rates from heart disease, coronary heart disease, stroke, and all causes. The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research data system was used to determine US mortality rates. Mortality rates for KPNC were determined from health system, Social Security vital status, and state death certificate databases.
Results |
Declines in age-adjusted mortality rates were noted in KPNC and the United States for heart disease (36.3% in KPNC vs 34.6% in the United States), coronary heart disease (51.0% vs 47.9%), stroke (45.5% vs 38.2%), and all-cause mortality (16.8% vs 15.6%). However, steeper declines were noted in KPNC than the United States among those aged 45 to 65 years for heart disease (48.3% KPNC vs 23.6% United States), coronary heart disease (55.6% vs 35.9%), stroke (55.8% vs 26.0%), and all-cause mortality (31.5% vs 9.1%). Sex-specific changes were generally similar.
Conclusions |
Despite significant declines in heart disease and stroke mortality, there remains an improvement gap nationally among those aged less than 65 years when compared with a large integrated healthcare delivery system. Interventions to improve cardiovascular mortality in the vulnerable middle-aged population may play a key role in closing this gap.
El texto completo de este artículo está disponible en PDF.Keywords : Heart disease, Mortality rate, Stroke
Esquema
| Funding: This study was conducted within the Cardiovascular Research Network, a consortium of research organizations initially sponsored by the National Heart Lung and Blood Institute (NHLBI) (U19 HL91179-01 and RC2 HL101666) and the American Recovery and Reinvestment Act of 2009 (ARRA). |
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| Conflicts of Interest: SS reports grants from the National Heart, Lung, and Blood Institute, and National Institute of Neurological Disorders and Stroke during the conduct of the study. ASG reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. MNN-H reports grants from the National Institute of Neurological Disorders and Stroke, outside the submitted work. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 131 - N° 7
P. 829 - juillet 2018 Regresar al número
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