Advertisement
Clinical Research Study|Articles in Press

Demographic and Regional Trends of Cardiovascular Diseases and Diabetes Mellitus-Related Mortality in the United States From 1999 to 2019

      Abstract

      Objective

      The purpose of this research was to study the contemporary trends in cardiovascular disease (CVD) and diabetes mellitus (DM)-related mortality.

      Methods

      We used the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database to identify adults ≥25 years old where both CVD and DM were listed as an underlying or contributing cause of death between 1999 and 2019. Crude and age-adjusted mortality rates per 100,000 population were determined.

      Results

      The overall age-adjusted mortality rate was 99.18 in 1999 and 91.43 in 2019, with a recent increase from 2014-2019 (annual percent change 1.0; 95% confidence interval [CI], 0.3-1.6). Age-adjusted mortality rate was higher for males compared with females, with increasing mortality in males between 2014 and 2019 (annual percent change 1.5; 95% CI, 0.9-2.0). Age-adjusted mortality rate was highest for non-Hispanic Black adults and was ∼2-fold higher compared with non-Hispanic White adults. Young and middle-aged adults (25-69 years) had increasing age-adjusted mortality rates in recent years. There were significant urban-rural disparities, and age-adjusted mortality rates in rural counties increased from 2014 to 2019 (annual percent change 2.2; 95% CI, 1.5-2.9); states in the 90th percentile of mortality had age-adjusted mortality rates that were ∼2-fold higher than those in the bottom 10th percentile of mortality.

      Conclusion

      After an initial decrease in DM + CVD-related mortality for a decade, this trend has reversed, with increasing mortality from 2014 to 2019. Significant geographic and demographic disparities persist, requiring targeted health policy interventions to prevent the loss of years of progress.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Centers for Disease Control and Prevention (CDC). Prevalence of both diagnosed and undiagnosed diabetes. 2022. Available at:https://www.cdc.gov/diabetes/data/statistics-report/diagnosed-undiagnosed-diabetes.html. Accessed January 26, 2022.

        • Fox CS
        • Pencina MJ
        • Meigs JB
        • Vasan RS
        • Levitzky YS
        • D'Agostino RB
        Trends in the incidence of type 2 diabetes mellitus from the 1970s to the 1990s: the Framingham Heart Study.
        Circulation. 2006; 113: 2914-2918
        • Stratton IM
        • Adler AI
        • Neil HA
        • et al.
        Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.
        BMJ. 2000; 321: 405-412
        • GBD 2015 Mortality and Causes of Death Collaborators
        Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.
        Lancet. 2016; 388: 1459-1544
        • Fox CS
        • Coady S
        • Sorlie PD
        • et al.
        Trends in cardiovascular complications of diabetes.
        JAMA. 2004; 292: 2495-2499
        • Gregg EW
        • Gu Q
        • Cheng YJ
        • Narayan KMV
        • Cowie CC
        Mortality trends in men and women with diabetes, 1971 to 2000.
        Ann Intern Med. 2007; 147: 149-155
        • Martín-Timón I
        • Sevillano-Collantes C
        • Segura-Galindo A
        • del Cañizo-Gómez FJ
        Type 2 diabetes and cardiovascular disease: have all risk factors the same strength?.
        World J Diabetes. 2014; 5: 444-470
        • Krishnan U
        • Brejt JA
        • Schulman-Marcus J
        • et al.
        Temporal trends in the clinical acuity of patients with ST-segment elevation myocardial infarction.
        Am J Med. 2018; 131: 100.e9-100.e20
        • American Diabetes Association
        9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes–2021.
        Diabetes Care. 2020; 44: S111-S124
        • Ibanez B
        • James S
        • Agewall S
        • et al.
        2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2018; 39: 119-177
      2. Centers for Disease Control and Prevention (CDC). About multiple cause of death, 1999-2020. Available at: https://wonder.cdc.gov/mcd-icd10.html. Accessed December 15, 2021.

        • Aggarwal R
        • Chiu N
        • Loccoh EC
        • Kazi DS
        • Yeh RW
        • Wadhera RK
        Rural-urban disparities: diabetes, hypertension, heart disease, and stroke mortality among black and white adults, 1999-2018.
        J Am Coll Cardiol. 2021; 77: 1480-1481
        • Khan MS
        • Kumar P
        • Sreenivasan J
        • et al.
        Rural-urban differences in mortality from ischemic heart disease, heart failure, and stroke in the United States.
        Circ Cardiovasc Qual Outcomes. 2021; 14e007341
        • Sidney S
        • Quesenberry Jr, CP
        • Jaffe MG
        • et al.
        Recent trends in cardiovascular mortality in the United States and public health goals.
        JAMA Cardiol. 2016; 1: 594-599
        • Manemann SM
        • Gerber Y
        • Bielinski SJ
        • et al.
        Recent trends in cardiovascular disease deaths: a state specific perspective.
        BMC Public Health. 2021; 21: 1031
        • Ingram DD
        • Franco SJ
        2013 NCHS urban-rural classification scheme for counties.
        Vital Health Stat 2. 2014; : 1-73
        • Anderson RN
        • Rosenberg HM
        Age standardization of death rates: implementation of the year 2000 standard.
        Natl Vital Stat Rep. 1998; 47: 1-16, 20
      3. Joinpoint Regression Program, Version 4.9.0.0 - March 2021; Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute. Available at: https://surveillance.cancer.gov/joinpoint/. Accessed November 22, 2021.

        • Tsao CW
        • Aday AW
        • Almarzooq ZI
        • et al.
        Heart disease and stroke statistics—2022 update: a report from the American Heart Association.
        Circulation. 2022; 145: e153-e639
        • Stark Casagrande S
        • Fradkin JE
        • Saydah SH
        • Rust KF
        • Cowie CC
        The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988-2010.
        Diabetes Care. 2013; 36: 2271-2279
        • Fox CS
        • Coady S
        • Sorlie PD
        • et al.
        Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart Study.
        Circulation. 2007; 115: 1544-1550
        • Preis SR
        • Hwang SJ
        • Coady S
        • et al.
        Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005.
        Circulation. 2009; 119: 1728-1735
        • Rosenstock S
        • Whitman S
        • West JF
        • Balkin M
        Racial disparities in diabetes mortality in the 50 most populous US cities.
        J Urban Health. 2014; 91: 873-885
        • Osei K
        • Gaillard T
        Disparities in cardiovascular disease and type 2 diabetes risk factors in blacks and whites: dissecting racial paradox of metabolic syndrome.
        Front Endocrinol (Lausanne). 2017; 8: 204
        • Woolf SH
        • Schoomaker H
        Life expectancy and mortality rates in the United States, 1959-2017.
        JAMA. 2019; 322: 1996-2016
        • Roth GA
        • Dwyer-Lindgren L
        • Bertozzi-Villa A
        • et al.
        Trends and patterns of geographic variation in cardiovascular mortality among US counties, 1980-2014.
        JAMA. 2017; 317: 1976-1992
        • Cross SH
        • Mehra MR
        • Bhatt DL
        • et al.
        Rural-urban differences in cardiovascular mortality in the US, 1999-2017.
        JAMA. 2020; 323: 1852-1854
        • Harrington RA
        • Califf RM
        • Balamurugan A
        • et al.
        Call to action: rural health: a presidential advisory from the American Heart Association and American Stroke Association.
        Circulation. 2020; 141: e615-e644
        • Bucholz EM
        • Gooding HC
        • de Ferranti SD
        Awareness of cardiovascular risk factors in U.S. young adults aged 18-39 years.
        Am J Prev Med. 2018; 54: e67-e77
        • Svane J
        • Lynge TH
        • Pedersen-Bjergaard U
        • et al.
        Cause-specific mortality in children and young adults with diabetes mellitus: a Danish nationwide cohort study.
        Eur J Prev Cardiol. 2019; 28: 159-165
        • Ellis RP
        • Hsu HE
        • Song C
        • et al.
        Diagnostic category prevalence in 3 classification systems across the transition to the International Classification of Diseases, Tenth Revision, Clinical Modification.
        JAMA Network Open. 2020; 3e202280
        • Lloyd-Jones DM
        • Martin DO
        • Larson MG
        • Levy D
        Accuracy of death certificates for coding coronary heart disease as the cause of death.
        Ann Intern Med. 1998; 129: 1020-1026
        • McEwen LN
        • Karter AJ
        • Curb JD
        • Marrero DG
        • Crosson JC
        • Herman WH
        Temporal trends in recording of diabetes on death certificates: results from Translating Research Into Action for Diabetes (TRIAD).
        Diabetes Care. 2011; 34: 1529-1533
        • Ahmad FB
        • Cisewski JA
        • Miniño A
        • Anderson RN
        Provisional mortality data—United States, 2020.
        MMWR Morb Mortal Wkly Rep. 2021; 70: 519-522