Progress in Chronic Disease Prevention
State- and Sex-Specific Premature Mortality Due to Ischemic Heart
Disease -- 1985
Heart disease is the leading cause of death in the United
States
and the third leading cause of years of potential life lost before
the
age of 65. Ischemic heart disease (IHD)* accounts for 71% of all
deaths due to heart disease and 27% of all mortality (1).
Data from the National Center for Health Statistics' mortality
public-use data tapes for 1985 were used to analyze the incidence
of
premature mortality due to IHD. Deaths from IHD were stratified by
gender for each of the 50 states and the District of Columbia.
Age-adjusted IHD death rates for all ages combined were computed
from
state population estimates for 1984, the latest year for which
age-
and gender-specific estimates are available (2). In addition,
rates of
premature mortality due to IHD per 100,000 persons aged 35-64 were
computed for each gender and state (Table 1, see page 320). To
facilitate interpretation, the states were grouped relative to the
national rate (less than 90%, 90%-110%, and greater than 110% of
the
national rate).
Age-adjusted IHD death rates for 1985 show similar geographic
patterns for both men and women. States experiencing age-adjusted
rates more than 10% above the national mean were located in the
Northeast and Midwest. States with age-adjusted rates at least 10%
below the national mean were around Chesapeake Bay; in the Rocky
Mountain, Northwest, and Southwest regions of the country; and in
Alaska and Hawaii.
Rates of premature mortality due to IHD in 1985 were also high
in
the parts of the Northeast and Midwest that experienced higher
rates
of age-adjusted IHD deaths (Figures 1 and 2). Additionally,
several
states in the Southeast and Appalachian regions experienced
premature
mortality from IHD that was more than 10% above the national mean.
With the addition of California and Connecticut, areas with IHD
premature mortality rates at least 10% below the national mean
were
similar to those with low age-adjusted IHD deaths.
Reported by: Epidemiology Br, Div of Nutrition, Center for Health
Promotion and Education, CDC.
Editorial Note: Current geographic variations in premature IHD
rates
are probably associated with long-term trends in overall IHD
deaths
(3-8). Although each age, sex, racial, and geographic group has
experienced significant declines in deaths from IHD, significant
differences exist. In 1950, the West Coast ranked as high as the
East
Coast states, but in the 1960s, the rate in the west began to
decline
(6). By 1978, the highest rates clustered in the Appalachian and
Northeastern regions. These regional trends in premature mortality
due
to IHD were similar for men and women as well as for blacks and
whites.
Some of the current differences in state-specific IHD
premature
mortality rates may result from sociodemographic differences or
population shifts over time. Blacks have higher rates of premature
IHD
(9). In addition, although blacks and whites had similar rates of
decline in IHD deaths from 1968-1975, the rate of decline among
white
females and blacks of both genders from 1975 to 1985 has been half
that of white men (10).
Finally, variations among states in IHD premature mortality
rates
may reflect geographic differences in the availability or
effectiveness of interventions against IHD or in the prevalence of
risk factors, such as cigarette smoking, high levels of serum
cholesterol, high blood pressure, overweight, and low levels of
physical activity. A review of available evidence suggests that
reductions in serum cholesterol and in cigarette smoking are
responsible for over half of the decline in overall IHD death
rates
over the last 2 decades (11).
Geographic variations in premature IHD, rather than
age-adjusted
IHD deaths for all ages combined, should direct epidemiologists
and
public-health practitioners in examining regional or
state-specific
patterns of risk factors known to contribute to premature
mortality
due to IHD. Furthermore, an examination of the environmental,
behavioral, and social factors underlying these differences in
risk
factors might be beneficial. These investigations may provide
insight
into the most promising prevention strategies.
References
National Center for Health Statistics. Vital statistics of the
United States, 1984. Vol II: Mortality, Part A. Washington,
DC: US
Department of Health and Human Services, Public Health
Service,
1987; DHHS publication no. (PHS)87-1122.
Bureau of the Census. County population estimates
(experimental)
by age, sex, and race: 1980, 1982, and 1984 (machine-readable
data
file). Washington, DC: Bureau of the Census, Data User
Services
Division, 1987.
Enterline PE, Stewart WH. Geographic patterns in deaths from
coronary heart disease. Public Health Rep 1956;71:849-55.
Sauer HI, Enterline PE. Are geographic variations in death
rates
for the cardiovascular diseases real? J Chronic Dis
1959;10:513-24.
Friedman GD. Cigarette smoking and geographic variation in
coronary heart disease mortality in the United States. J
Chronic
Dis 1967;20:769-79.
Leaverton PE, Feinleib M, Thom T. Coronary heart disease
mortality
in United States blacks, 1968-1978: interstate variation. Am
Heart
J 1984;108:732-7.
Levy RI. The decline in cardiovascular disease mortality. Annu
Rev
Public Health 1981; 2:49-70.
Ragland KE, Selvin S, Merrill DW. The onset of decline in
ischemic
heart disease mortality in the United States. Am J Epidemiol
1988;127:516-31.
Centers for Disease Control. Health, United States, 1987.
Hyattsville, Maryland: US Department of Health and Human
Services,
Public Health Service; DHHS publication no. (PHS)88-1232.
Sempos C, Cooper R, Kovar MG, McMillen M. Divergence of the
recent
trends in coronary mortality for the four major race-sex
groups in
the United States. Am J Public Health (in press).
Goldman L, Cook EF. The decline in ischemic heart disease
mortality rates: an analysis of the comparative effects of
medical
interventions and changes in lifestyle. Ann Intern Med
1984;101:825-36.
*International Classification of Diseases, 9th Revision, codes
410-414.
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