Changes in the Geographic Patterns of Heart Disease Mortality in the United States 1973 to 2010
Changes in the Geographic Patterns of Heart Disease Mortality in the United States 1973 to 2010
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DOI：
10.1161/circulationaha.115.018663
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发表时间：
2016-03-22
期刊：
影响因子：
37.8
通讯作者：
Greer, Sophia
中科院分区：
文献类型：
--
作者：
Casper, Michele;Kramer, Michael R.;Greer, Sophia
背景-尽管许多研究已经证明了美国全国范围内心脏病死亡率的急剧下降，方法和结果-年龄调整和空间平滑的县级心脏病死亡率计算为2- 10年，对于年龄>= 35岁的人，年份间隔为1973年至1974年至2009年至2010年。心脏病死亡是根据《国际疾病分类》第八、第九和第十次修订版中的心脏疾病代码定义的。一个完全贝叶斯时空模型被用来产生精确的速率估计，即使在人口较少的县。据观察，高税率县的集中程度从东北部向南部腹地发生了重大变化，沿着南部缓慢下降的县的集中和县之间地理不平等的近2倍的增加。结论-40年来心脏病死亡率地理模式的巨大变化突出了小-区域监测揭示隐藏在国家一级的模式，为社区了解其目前的心脏病负担提供历史背景，并为了解心脏病死亡率地理差异的决定因素提供重要线索。
Background-Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality.Methods and Results-Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged >= 35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases. A fully Bayesian spatiotemporal model was used to produce precise rate estimates, even in counties with small populations. A substantial shift in the concentration of high-rate counties from the Northeast to the Deep South was observed, along with a concentration of slow-decline counties in the South and a nearly 2-fold increase in the geographic inequality among counties.Conclusions-The dramatic change in the geographic patterns of heart disease mortality during 40 years highlights the importance of small-area surveillance to reveal patterns that are hidden at the national level, gives communities the historical context for understanding their current burden of heart disease, and provides important clues for understanding the determinants of the geographic disparities in heart disease mortality.