Recent Trends in Cardiovascular Mortality in the United States and Public Health Goals
Recent Trends in Cardiovascular Mortality in the United States and Public Health Goals
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DOI：
10.1001/jamacardio.2016.1326
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发表时间：
2016-08-01
期刊：
影响因子：
24
通讯作者：
Rana, Jamal S.
中科院分区：
文献类型：
--
作者：
Sidney, Stephen;Quesenberry, Charles P., Jr.;Rana, Jamal S.
心脏病（HD）和癌症是美国的两大死亡原因。在21世纪的第一个十年期间，HD死亡率以比癌症死亡率大得多的速度下降，并且似乎癌症将超过HD作为主要死亡原因。设置和参与者疾病控制和预防中心流行病学研究数据系统的广泛在线数据用于确定2000年1月1日至2011年12月31日和2011年1月1日至2014年12月31日期间所有CVD，HD，中风和癌症导致的年龄调整死亡率的全国趋势，总体上按性别划分，种族/民族。研究时间为2105年12月30日至2016年1月18日。主要结果和指标比较HD与癌症死亡率差距的年变化率和趋势。结果2011年后，所有CVD、HD和脑卒中死亡率的下降速度大幅放缓，癌症死亡率的下降速度保持相对稳定。2000-2011年的年下降率以百分比（95% CI）表示，为3.79%（3.61%至3.97%）、3.69%（3.51%至3.87%）、4.53%（4.34%至4.72%）和1.49%（1.37%至1.60%）的所有CVD，HD，中风和癌症的死亡率分别; 2011-2014年的比率分别为0.65%（-0.18%至1.47%）、0.76%（-0.06%至1.58%）、0.37%（-0.53%至1.27%）和1.55%（1.07%至2.04%）。所有CVD死亡率的下降速度在男性、女性和所有种族/民族组中均有所减缓。例如，2000-2011年总心血管疾病死亡率的年下降率为3.69%（3.48%至3.89%），女性为3.98%（3.81%至4.14%）; 2011-2014年，比率分别为0.23%（-0.71%至1.16%）和1.17%（0.41%至1.93%）。HD和癌症死亡率之间的差距持续存在。结论和相关性自2011年以来，所有CVD、HD和卒中死亡率的下降速度均有所减缓。如果这种趋势继续下去，美国心脏协会和百万心脏计划制定的降低心血管疾病负担的战略目标可能无法实现。
IMPORTANCE Heart disease (HD) and cancer are the 2 leading causes of death in the United States. During the first decade of the 21st century, HD mortality declined at a much greater rate than cancer mortality and it appeared that cancer would overtake HD as the leading cause of death.OBJECTIVES To determine whether changes in national trends had occurred in recent years in mortality rates due to all cardiovascular disease (CVD), HD, stroke, and cancer and to evaluate the gap between mortality rates from HD and cancer.DESIGN, SETTING, AND PARTICIPANTS The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research data system was used to determine national trends in age-adjusted mortality rates due to all CVD, HD, stroke, and cancer from January 1, 2000, to December 31, 2011, and January 1, 2011, to December 31, 2014, overall, by sex, and by race/ethnicity. The present study was conducted from December 30, 2105, to January 18, 2016.MAIN OUTCOMES AND MEASURES Comparison of annual rates of change and trend in gap between HD and cancer mortality rates.RESULTS The rate of the decline in all CVD, HD, and stroke mortality decelerated substantially after 2011, and the rate of decline for cancer mortality remained relatively stable. Reported as percentage (95% CI), the annual rates of decline for 2000-2011 were 3.79% (3.61% to 3.97%), 3.69%(3.51% to 3.87%), 4.53%(4.34% to 4.72%), and 1.49%(1.37% to 1.60%) for all CVD, HD, stroke, and cancer mortality, respectively; the rates for 2011-2014 were 0.65% (-0.18% to 1.47%), 0.76%(-0.06% to 1.58%), 0.37%(-0.53% to 1.27%), and 1.55%(1.07% to 2.04%), respectively. Deceleration of the decline in all CVD mortality rates occurred in males, females, and all race/ethnicity groups. For example, the annual rates of decline for total CVD mortality for 2000-2011 were 3.69%(3.48% to 3.89%) for males and 3.98% (3.81% to 4.14%) for females; for 2011-2014, the rates were 0.23%(-0.71% to 1.16%) and 1.17%(0.41% to 1.93%), respectively. The gap between HD and cancer mortality persisted.CONCLUSIONS AND RELEVANCE Deceleration in the decline of all CVD, HD, and stroke mortality rates has occurred since 2011. If this trend continues, strategic goals for lowering the burden of CVD set by the American Heart Association and the Million Hearts Initiative may not be reached.