Abstract
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.
Keywords
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Article info
Publication history
Published online: April 02, 2018
Footnotes
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).
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.
Authorship: All authors had access to the data and played a role in writing this manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
