 |
 
|
 |
 |
| |
 |
|
|
| ||||||||||
|
|
|
|
|
|
|
||||
| ||||||||||
 |
|
|
|
Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Mortality from Congestive Heart Failure -- United States, 1980-1990In the United States, congestive heart failure (CHF) was the underlying cause of death for approximately 38,000 persons in 1990; of those deaths, approximately 92% were among persons aged greater than or equal to 65 years. CHF, a clinical syndrome defined as a chronic inadequate contraction of the heart muscle resulting in insufficient cardiac output, is a manifestation of one or more underlying conditions, including systemic or pulmonary hypertension or a history of other heart diseases (e.g., myocardial infarction, atherosclerosis, cardiomyopathy, congenital heart disease, or rheumatic fever). The long-term prognosis of CHF depends on the underlying condition and the response of that condition to treatment. Despite declines in death rates for ischemic heart disease and cerebrovascular disease (1,2), improvements in detection and treatment of hypertension (3), and considerable advances in the diagnosis and management of CHF (4), mortality from CHF has increased since 1980 (5). This report summarizes trends in CHF mortality in the United States during 1980-1990 and presents state-specific mortality data for 1990 (the most recent year for which such data are available). Public-use mortality data tapes compiled by CDC's National Center for Health Statistics and population estimates from the U.S. Bureau of the Census were used to calculate crude and age-adjusted CHF death rates for the U.S. population. CHF deaths were defined as deaths for which the underlying cause was listed on the death certificate as International Classification of Diseases, Ninth Revision, codes 428.0-428.9. State- and group-specific age-adjusted estimates were standardized to the 1980 U.S. population. Race-specific denominator data were available only for blacks and whites. In 1990, a total of 37,935 deaths resulted from CHF. Crude death rates for CHF per 100,000 persons were directly proportionate to age. For persons aged greater than or equal to 85 years, the crude death rate was 559.1 -- fivefold higher than the rate for persons aged 75-84 years (124.7) and 18-fold higher than that for persons aged 65-74 years (31.6). The age-adjusted death rate for CHF among persons aged greater than or equal to 65 years was 143.9 for black men, 117.8 for white men, 113.4 for black women, and 97.5 for white women. Crude death rates for CHF increased during 1980-1988 for persons aged greater than or equal to 65 years (Figure_1); rates declined slightly during 1989-1990. For persons aged greater than or equal to 65 years, age-adjusted death rates for CHF increased during 1980-1988 for each of the race and sex groups (Figure_2); rates were higher among blacks and men. In 1990, age-adjusted CHF death rates varied substantially among the states and ranged from 3.7 (Florida) to 31.5 (Alabama) (Table_1). For persons aged greater than or equal to 65 years, state-specific CHF death rates ranged from 29.9 (Florida) to 246.2 (Alabama). Reported by: Cardiovascular Health Studies Br and Statistics Br, Div of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial NoteEditorial Note: In the United States, an estimated 1-2 million persons aged 25-74 years are affected by CHF (6). The impact of CHF is particularly severe among the elderly because of the emotional and economic burdens (e.g., functional disability, long-term pharmacologic therapy, and frequent hospitalizations) associated with the syndrome. In addition, the prognosis for CHF is poor: for example, of newly diagnosed cases in Rochester, Minnesota, in 1981, survival following diagnosis was 80% at 3 months, 66% at 1 year, and 30% at 8 years (7). The findings in this report document substantial increases in CHF death rates during 1980-1990 among persons in older age groups. Potential explanations for these increases, and for increases in hospitalization rates for CHF, include the increasing average age of the U.S. population and the longer survival of persons with hypertension or symptomatic cardiac diseases who subsequently develop CHF at an older age (3,5,8). Race-specific variations in CHF death rates especially may reflect the substantially higher prevalence and greater severity of hypertension among blacks. In addition, hospitalization (8) and death rates for CHF (5) were higher for younger blacks than for whites, suggesting an earlier onset of disease and perhaps greater severity of CHF among blacks. Potential explanations for regional variations in CHF mortality include differences in prevalences of underlying conditions, in access to early diagnosis and/or therapeutic management of CHF and its underlying conditions, and in coding of death certificates. Because the U.S. Standard Certificate of Death was revised in 1989 to improve specificity of causes of death (9), the declines in CHF mortality during 1989 and 1990 may reflect deaths attributed to specific precipitating diseases rather than actual declines in CHF (5). In addition, the derivation of rates based on underlying cause-of-death listings also may account for an underestimation of CHF-related deaths: for example, in 1988, CHF was mentioned on death certificates as a contributing or sec- ondary cause approximately five times more often than as the underlying cause (5). Despite progress in the treatment of CHF (4), public health efforts should continue to target prevention and treatment of the underlying conditions associated with increased risk for CHF. For most U.S. residents, primary prevention of CHF includes adherence to lifestyles associated with prevention of hypertension and myocardial infarction (e.g., reduced dietary fat and/or sodium, weight maintenance, regular physical activity, and smoking cessation). References
TABLE 1. Number of deaths from and age-adjusted death rates for congestive heart
failure* among persons aged >=65 years+ and overall &, by state -- United States, 1990
======================================================================================
Persons aged >=65 yrs Overall
----------------------- ---------------
State No. Rate No. Rate
-------------------------------------------------------------------------------------
Alabama 1,322 246.2 1,464 31.5
Alaska 12 72.9 15 9.2
Arizona 454 99.5 502 12.7
Arkansas 706 186.5 758 23.4
California 1,791 55.4 1,942 6.9
Colorado 170 48.6 184 6.0
Connecticut 469 96.6 483 11.4
Delaware 89 112.1 92 13.2
District of Columbia 95 117.6 118 17.6
Florida 722 29.9 766 3.7
Georgia 949 145.5 1,056 18.4
Hawaii 83 72.9 90 8.9
Idaho 140 110.2 150 13.7
Illinois 1,997 129.3 2,145 16.0
Indiana 1,174 155.7 1,267 19.4
Iowa 452 85.2 462 10.0
Kansas 630 150.0 656 18.1
Kentucky 913 184.7 1,012 23.7
Louisiana 771 161.0 887 21.3
Maine 170 92.5 185 11.8
Maryland 597 116.5 654 14.5
Massachusetts 1,168 126.2 1,235 15.5
Michigan 1,246 107.9 1,314 13.0
Minnesota 659 98.4 681 11.7
Mississippi 742 216.7 809 27.4
Missouri 1,018 124.0 1,090 15.5
Montana 165 144.7 172 17.4
Nebraska 435 155.9 468 19.9
Nevada 152 143.3 175 18.1
New Hampshire 148 107.0 157 13.0
New Jersey 805 76.7 866 9.5
New Mexico 174 108.2 185 13.0
New York 2,328 91.2 2,514 11.4
North Carolina 768 96.3 832 11.9
North Dakota 161 141.7 170 17.6
Ohio 1,787 121.4 1,914 15.0
Oklahoma 804 169.0 858 20.9
Oregon 411 97.7 423 11.5
Pennsylvania 2,229 118.6 2,412 14.9
Rhode Island 92 56.6 96 6.8
South Carolina 495 132.8 568 17.3
South Dakota 145 113.8 154 14.3
Tennessee 595 92.2 650 11.6
Texas 1,557 86.9 1,756 11.2
Utah 231 149.5 242 17.8
Vermont 69 91.3 73 11.1
Virginia 978 147.4 1,094 18.8
Washington 641 104.7 665 12.4
West Virginia 444 159.2 483 20.1
Wisconsin 856 113.9 907 14.0
Wyoming 83 167.9 84 19.3
Total 35,092 106.4 37,935 13.3
-------------------------------------------------------------------------------------------
* International Classification of Diseases, Ninth Revision, codes 428.0-428.9.
+Per 100,000 population; standardized to the 1980 U.S. Bureau of the Census population aged
>=65 years.
&Per 100,000 population; standardized to the 1980 U.S. Bureau of the Census population.
============================================================================================
Return to top. Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.Page converted: 09/19/98 |
| |||||||
This page last reviewed 5/2/01
|
