Rural-Urban Trends for Aortic Stenosis Mortality in the United States, 2008-2019.
Rural-Urban Trends for Aortic Stenosis Mortality in the United States, 2008-2019.
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2008-2019 年美国主动脉瓣狭窄死亡率的城乡趋势。
DOI：
10.1016/j.jacadv.2023.100617
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Khan,SadiyaS
中科院分区：
文献类型：
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作者：
Hughes,ZacharyH;Hammond,MichaelM;Lewis-Thames,Marquita;Sweis,Ranya;Shah,NilayS;Khan,SadiyaS
严重的主动脉瓣狭窄（AS）在症状出现后2年内的死亡率约为50%。1随着经导管主动脉瓣置换术（TAVR）的出现，以前手术风险过高的老年患者现在有了持久的治疗选择。随着2013年TAVR的使用变得更加普遍，观察到AS导致的全国年龄调整死亡率（AAMR）显著降低。2尽管如此，TAVR仍然是一种技术密集型手术，需要多学科的卫生专业人员团队，这限制了资源有限地区患者的可及性，因此可能限制农村居民的实际受益。3美国心脏协会发布了一项行动呼吁，以解决生活在美国农村的人们的独特健康需求，以减少并理想地消除这一人群长期存在的健康差距。为了确定改善AS结局的机会，我们比较了2008年至2019年美国农村和城市地区AS死亡率的时间趋势。我们使用了2008年至2019年疾病控制和预防中心流行病学研究数据库的广泛在线数据。当AS是潜在死亡原因时，计算AAMR（标准化为2000年美国人群）和年龄特异性死亡率（国际疾病分类-10编码I 06）。0，I06。2，I35。0和I35。20）。使用国家卫生统计中心城乡分类方案按县级城市化对死者进行分类：4个城市（大中心城市、大边缘城市、中等城市、小城市地区）和2个农村（小城市、非核心地区）。发病率按年龄（< 75岁和75美元）、性别、种族和民族分层。通过使用Stata版本16（StataCorp）拟合分段回归模型来表征发病率的时间趋势。AAMR比率和相应的95% CI代表城市化程度较低的县每100，000人中的死亡人数，以及大型中心城市县每100，000人中的死亡人数。这项研究免于西北大学机构审查委员会的审查，因为数据是去识别和公开的。2008年至2019年，有167，808人死于AS。2019年的AAMR（标准误）分别为每10万人中的大型中心大都市2.8（0.1），大型边缘大都市3.4（0.1），中型大都市3.7（0.1），小型大都市3.9（0.1），微型大都市县4.0（0.1）和非核心县3.6（0.1）。在总体AAMR趋势中观察到一个显著的拐点（图1），2008年至2013年AS死亡率停滞不前（每10万人口AAMR年度变化的回归系数为0.02; 95% CI：0.000）。03至0.07），其次是2013年至2019年的AAMR下降（2010年至2019年）。10; 95% CI：≥ 0。13到100 07）。2013年，大型中心城市和非核心县死者之间的ASMR 75岁相似（分别为每10万人51.8 [1.0]和54.2 [1.9]; AAMR比率1.04 [0.97-1.13]）但在整个研究期间，ASMR的差异扩大了，与老年人相比，2019年，非核心县对应机构（每10万人分别为45.6 [0.9]和54.1 [1.8]; AAMR比率为1.19 [95% CI：1.10-1.28]）。从2008年到2019年，非核心县的ASMR没有变化（每10万人54.2 [1.9]-54.1 [1.8]）。从2013年到2019年，与大都市相比，所有城市化类别的AAMR比率都有所增加（图1），其中AAMR比率增幅最高的是...
Severe aortic stenosis (AS) confers an approximate mortality rate of 50% within 2 years after the development of symptoms. 1 With the advent of transcatheter aortic valve replacement (TAVR), older patients with previously prohibitive surgical risk now have a durable therapeutic option. Significant reductions in national age-adjusted mortality rates (AAMRs) due to AS have been observed as the use of TAVR has become more ubiquitous in 2013. 2 Despite this, TAVR remains a technically intensive procedure requiring a multidisciplinary team of health professionals, which limits accessibility for patients in resource-limited areas and therefore may limit benefits actualized by rural residents. 3 The American Heart Association released a call to action to address the unique health needs of people living in rural America to reduce and ideally eliminate longstanding health disparities in this population. 4 To identify opportunities to improve AS outcomes, we compared temporal trends in AS mortality in rural and urban regions of the United States from 2008 to 2019. We used the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research database from 2008 to 2019. AAMRs (standardized to the 2000 US population) and agespecific mortality rates were calculated when AS was the underlying cause of death (International Classification of Disease-10 codes I06. 0, I06. 2, I35. 0, and I35. 20). Decedents were categorized by countylevel urbanization using the National Center for Health Statistics Urban-Rural Classification Scheme: 4 urban (large central metropolitan, large fringe metropolitan, medium metropolitan, small metropolitan areas) and 2 rural (micropolitan, noncore areas). Rates were stratified by age (< 75 and $75 years), sex, race, and ethnicity. Temporal trends in rates were characterized by fitting piecewise regression models using Stata version 16 (StataCorp).AAMR ratios and respective 95% CIs represented the number of deaths per 100,000 population in less urbanized counties for every 1 death per 100,000 population in large central metropolitan counties. This study was exempt from review by the Institutional Review Board at Northwestern University because the data are deidentified and publicly available. Between 2008 and 2019, there were 167,808 deaths from AS. AAMRs (standard error) in 2019 were 2.8 (0.1) in large central metropolitan, 3.4 (0.1) in large fringe metropolitan, 3.7 (0.1) in medium metropolitan, 3.9 (0.1) in small metropolitan, 4.0 (0.1) in micropolitan counties, and 3.6 (0.1) in noncore counties per 100,000, respectively. A significant inflection point was observed in overall AAMR trend (Figure 1) with stagnant rates for AS mortality from 2008 to 2013 (regression coefficient for annual change in AAMR per 100,000 population, 0.02; 95% CI: À0. 03 to 0.07), followed by a decrease in AAMR from 2013 to 2019 (À0. 10; 95% CI: À0. 13 to À0. 07). ASMRs between large central metropolitan and noncore county decedents $75 years were similar in 2013 (51.8 [1.0] and 54.2 [1.9] per 100,000 respectively; AAMR ratio 1.04 [0.97-1.13]) but the difference in ASMRs widened throughout the study period with older large central metropolitan residents having significantly lower rates compared with older noncore county counterparts in 2019 (45.6 [0.9] and 54.1 [1.8] per 100,000, respectively; AAMR ratio 1.19 [95% CI: 1.10-1.28]). There was no change in ASMR for $75 years in noncore counties from 2008 to 2019 (54.2 [1.9]-54.1 [1.8] per 100,000). AAMR ratios increased for all urbanization categories compared with large metropolitan from 2013 to 2019 (Figure 1), with the highest increase in AAMR ratio seen in …
影响因子：
37.8
作者：
Harrington, Robert A.;Califf, Robert M.;Maddox, Karen E. Joynt
通讯作者：
Maddox, Karen E. Joynt