TY - JOUR
T1 - Adverse trends in premature cardiometabolic mortality in the united states, 1999 to 2018
AU - Shah, Nilay S.
AU - Lloyd-Jones, Donald M.
AU - Kandula, Namratha R.
AU - Huffman, Mark D.
AU - Capewell, Simon
AU - O’flaherty, Martin
AU - Kershaw, Kiarri N.
AU - Carnethon, Mercedes R.
AU - Khan, Sadiya S.
N1 - Funding Information:
Research reported in this publication was supported, in part, by the National Heart, Lung, and Blood Institute grant number F32HL149187 (Dr Shah) and by the NIH’s National Center for Advancing Translational Sciences, grant number KL2TR001424 (Dr Khan). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Research reported in this publication was also supported, in part, by the
Funding Information:
Dr Huffman has received support from the American Heart Association, Verily, and AstraZeneca for work unrelated to this research. He has received salary support from the American Medical Association for his role as an associate editor for JAMA Cardiology. He has a secondary appointment at the George Institute for Global Health, which has a patent, license, and intent to commercialize fixed-dose combination therapy through its social enterprise business, George Medicines, for which the organization has received investments. The remaining authors have no disclosures to report.
Funding Information:
Research reported in this publication was supported, in part, by the National Heart, Lung, and Blood Institute grant number F32HL149187 (Dr Shah) and by the NIH?s National Center for Advancing Translational Sciences, grant number KL2TR001424 (Dr Khan). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Research reported in this publication was also supported, in part, by the American Heart Association (#19TPA34890060) to Dr Khan.
Publisher Copyright:
© 2020 The Authors.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - BACKGROUND: Life expectancy in the United States has recently declined, in part attributable to premature cardiometabolic mortality. We characterized national trends in premature cardiometabolic mortality, overall, and by race-sex groups. METHODS AND RESULTS: Using death certificates from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research, we quantified premature deaths (<65 years of age) from heart disease, cerebrovascular disease, and diabetes mellitus from 1999 to 2018. We calculated age-adjusted mortality rates (AAMRs) and years of potential life lost (YPLL) from each cardiometabolic cause occurring at <65 years of age. We used Joinpoint regression to identify an inflection point in overall cardiometabolic AAMR trends. Average annual percent change in AAMRs and YPLL was quantified before and after the identified inflection point. From 1999 to 2018, annual premature deaths from heart disease (117 880 to 128 832), cerebrovascular disease (18 765 to 20 565), and diabetes mellitus (16 553 to 24 758) as an underlying cause of death increased. By 2018, 19.7% of all heart disease deaths, 13.9% of all cerebrovascular disease deaths, and 29.1% of all diabetes mellitus deaths were premature. AAMRs and YPLL from heart disease and cerebrovascular disease declined until the inflection point identified in 2011, then remained unchanged through 2018. Conversely, AAMRs and YPLL from diabetes mellitus did not change through 2011, then increased through 2018. Black men and women had higher AAMRs and greater YPLL for each cardiometabolic cause compared with White men and women, respectively. CONCLUSIONS: Over one-fifth of cardiometabolic deaths occurred at <65 years of age. Recent stagnation in cardiometabolic AAMRs and YPLL are compounded by persistent racial disparities.
AB - BACKGROUND: Life expectancy in the United States has recently declined, in part attributable to premature cardiometabolic mortality. We characterized national trends in premature cardiometabolic mortality, overall, and by race-sex groups. METHODS AND RESULTS: Using death certificates from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research, we quantified premature deaths (<65 years of age) from heart disease, cerebrovascular disease, and diabetes mellitus from 1999 to 2018. We calculated age-adjusted mortality rates (AAMRs) and years of potential life lost (YPLL) from each cardiometabolic cause occurring at <65 years of age. We used Joinpoint regression to identify an inflection point in overall cardiometabolic AAMR trends. Average annual percent change in AAMRs and YPLL was quantified before and after the identified inflection point. From 1999 to 2018, annual premature deaths from heart disease (117 880 to 128 832), cerebrovascular disease (18 765 to 20 565), and diabetes mellitus (16 553 to 24 758) as an underlying cause of death increased. By 2018, 19.7% of all heart disease deaths, 13.9% of all cerebrovascular disease deaths, and 29.1% of all diabetes mellitus deaths were premature. AAMRs and YPLL from heart disease and cerebrovascular disease declined until the inflection point identified in 2011, then remained unchanged through 2018. Conversely, AAMRs and YPLL from diabetes mellitus did not change through 2011, then increased through 2018. Black men and women had higher AAMRs and greater YPLL for each cardiometabolic cause compared with White men and women, respectively. CONCLUSIONS: Over one-fifth of cardiometabolic deaths occurred at <65 years of age. Recent stagnation in cardiometabolic AAMRs and YPLL are compounded by persistent racial disparities.
KW - Cerebrovascular disease
KW - Diabetes mellitus
KW - Heart disease
KW - Mortality
KW - Premature
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U2 - 10.1161/JAHA.120.018213
DO - 10.1161/JAHA.120.018213
M3 - Article
C2 - 33222597
AN - SCOPUS:85097004328
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 23
M1 - e018213
ER -