Disparities in Premature Cardiac Death Among US Counties From 1999-2017: Temporal Trends and Key Drivers.
Disparities in Premature Cardiac Death Among US Counties From 1999-2017: Temporal Trends and Key Drivers.
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1999 年至 2017 年美国各县心源性过早死亡的差异：时间趋势和主要驱动因素
DOI：
10.1161/jaha.120.016340
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发表时间：
2020-08-04
影响因子：
5.4
通讯作者：
Zheng ZJ
中科院分区：
文献类型：
--
作者：
Jin Y;Song S;Zhang L;Trisolini MG;Labresh KA;Smith SC Jr;Zheng ZJ
心脏病过早死亡(PCD)的差异可能会阻碍美国和世界范围内减少PCD的进展。我们估计了美国各县之间PCD发病率的差异，并调查了与差异相关的县级因素。我们使用了美国的死因数据和死亡证明中的人口统计数据，以及多个数据库中的县级特征数据。PCD被定义为根据国际疾病分类第十版(ICD-10)代码，发生在35岁至74岁之间的任何死亡，其潜在死因是心脏病。在1999-2017年间发生的1,598,173例PCD中，60.9%是出院的。尽管PCD发生率从1999-2017年间下降，但院外PCD在所有心脏死亡中的比例从58.3%上升到61.5%。从1999年(泰尔指数=0.10)到2017年(泰尔指数=0.23)，各县PCD发病率的地理差异扩大，州内差异占大多数(2017年为57.4%)。与人口构成、社会经济因素、医疗环境和人群健康状况相关的院外PCD发生率(和住院PCD发生率)分别为36.51%和37.51%、18.64%和18.36%、23.73%和30.23%。美国各县的PCD发病率存在差异，这可能与中年人PCD发病率下降的减速趋势有关。出院率的缓慢下降需要更精确的目标定位和持续的努力，以确保在更好的健康水平(与较低的PCD率)对抗PCD方面取得进展。
Disparities in premature cardiac death (PCD) might stagnate the progress toward the reduction of PCD in the United States and worldwide. We estimated disparities across US counties in PCD rates and investigated county‐level factors related to the disparities. We used US mortality data for cause‐of‐death and demographic data from death certificates and county‐level characteristics data from multiple databases. PCD was defined as any death that occurred at an age between 35 and 74 years with an underlying cause of death caused by cardiac disease based on International Classification of Diseases, Tenth Revision (ICD‐10), codes. Of the 1 598 173 PCDs that occurred during 1999–2017, 60.9% were out of hospital. Although the PCD rates declined from 1999–2017, the proportion of out‐of‐hospital PCDs among all cardiac deaths increased from 58.3% to 61.5%. The geographic disparities in PCD rates across counties widened from 1999 (Theil index=0.10) to 2017 (Theil index=0.23), and within‐state differences accounted for the majority of disparities (57.4% in 2017). The disparities in out‐of‐hospital PCD rates (and in‐hospital PCD rates) associated with demographic composition were 36.51% (and 37.51%), socioeconomic features were 18.64% (and 18.36%), healthcare environment were 18.64% (and 13.90%), and population health status were 23.73% (and 30.23%). Disparities in PCD rates exist across US counties, which may be related to the decelerated trend of decline in the rates among middle‐aged adults. The slower declines in out‐of‐hospital rates warrants more precision targeting and sustained efforts to ensure progress at better levels of health (with lower PCD rates) against PCD.