Rural-Urban Differences in Mortality From Ischemic Heart Disease, Heart Failure, and Stroke in the United States

摘要

Rural areas experience higher age-adjusted mortality rates (AAMR) from cardiovascular disease than urban areas. However, trends for major cardiovascular disease subgroups remain unknown. Therefore, we analyzed trends in AAMR by urban-rural status for major cardiovascular disease subtypes: ischemic heart disease (IHD), heart failure (HF), and stroke. We queried the publicly available, nationally representative deidentified CDC Wide-ranging Online Data for Epidemiological Research database for deaths secondary to IHD, HF, and stroke from 1999 to 2017. The analysis was considered exempt from Institutional Review Board approval. Annual AAMR estimates of deaths per 100000 population from IHD, HF, and stroke were obtained using International Classification of Diseases codes for large metropolitan (>=1 million), small-medium metropolitan (50000-999999), and nonmetropolitan rural (<50000) areas. We used the Poisson regression with log link and robust standard errors to estimate annual percentage change (APC) in AAMR across 1999 to 2011 and 2011 to 2017 as the year 2011 has been previously used as an inflection point to assess recent changes in cardiovascular disease AAMR. The coefficients for the year obtained from the regression model were used to calculate the APC estimates [APC=100x (exp[coefficient]-1)]. Post hoc Bonferroni correction was used to ensure consistency of our results. The Pearson x~2 test was performed for categorical variables. A 2-tailed P value of <0.05 was considered statistically significant.