Trends and Patterns of Differences in Chronic Respiratory Disease Mortality Among US Counties, 1980-2014
Trends and Patterns of Differences in Chronic Respiratory Disease Mortality Among US Counties, 1980-2014
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DOI：
10.1001/jama.2017.11747
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发表时间：
2017-09-26
影响因子：
120.7
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
--
作者：
Dwyer-Lindgren, Laura;Bertozzi-Villa, Amelia;Murray, Christopher J. L.
重要性慢性呼吸系统疾病是美国死亡和残疾的重要原因。目的估计年龄标准化死亡率县慢性呼吸系统疾病。设计，设置和参与者验证小面积估计模型被应用到去识别死亡记录从国家卫生统计中心和人口计数从美国人口普查局，国家卫生统计中心，和人类死亡率数据库，以估计1980年至2014年慢性呼吸道疾病的县级死亡率。暴露居住县。主要结果和指标按县、年、性别和原因划分的标准化死亡率。结果自1月1日起，美国共有4 616 711例慢性呼吸道疾病死亡，1980年至2014年12月31日。在全国范围内，慢性呼吸道疾病的死亡率从40.8（95%不确定区间[UI]，39.8-41.8）1980年每10万人口死亡人数达到55.4人的峰值（95% UI，54.1-56.5）每10万人口死亡，然后在2014年下降到每10万人口52.9（95% UI，51.6-54.4）死亡。总体29.7%（95% UI，25.5%-33.8%）1980年至2014年慢性呼吸道疾病死亡率的增加反映了慢性阻塞性肺疾病死亡率的增加（30.8%[95% UI，25.2%-39.0%]，从34.5 [95% UI，33.0-35.5]至45.1 [95% UI，43.7-46.9]例死亡/100 000人群）、间质性肺病和肺结节病（减少100.5%[95% UI，5.8%-155.2%]，从每10万人口2.7 [95% UI，2.3-4.2]例死亡降至5.5 [95% UI，3.5-6.1]例死亡），以及所有其他慢性呼吸道疾病（42.3%[95% UI，32.4%-63.8%]，从每10万人口0.51 [95% UI，0.48-0.54]例死亡增加到0.73 [95% UI，0.69-0.78]例死亡）。各县之间的死亡率和死亡率随时间的变化有很大差异，地理模式因原因而异。死亡率最高的县主要分布在阿巴拉契亚中部的慢性阻塞性肺病和尘肺病;广泛分布在西南部、北方大平原、新英格兰和南大西洋的间质性肺病;沿着密西西比河的南半部以及格鲁吉亚和南卡罗来纳州的哮喘;以及从密西西比到南卡罗来纳州的南部各州的其他慢性呼吸道疾病。结论和相关性尽管最近慢性呼吸道疾病的死亡率下降，2014年的死亡率仍明显高于1980年。在1980年至2014年期间，死亡率和死亡率的变化在县，性别和特定的慢性呼吸道疾病类型之间存在重要差异。这些估计可能有助于为改善预防、诊断和治疗提供信息。
IMPORTANCE Chronic respiratory diseases are an important cause of death and disability in the United States.OBJECTIVE To estimate age-standardized mortality rates by county from chronic respiratory diseases.DESIGN, SETTING, AND PARTICIPANTS Validated small area estimation modelswere applied to deidentified death records from the National Center for Health Statistics and population counts from the US Census Bureau, National Center for Health Statistics, and Human Mortality Database to estimate county-level mortality rates from 1980 to 2014 for chronic respiratory diseases.EXPOSURE County of residence.MAIN OUTCOMES AND MEASURES Age-standardized mortality rates by county, year, sex, and cause.RESULTS A total of 4 616 711 deaths due to chronic respiratory diseases were recorded in the United States from January 1, 1980, through December 31, 2014. Nationally, the mortality rate from chronic respiratory diseases increased from 40.8 (95% uncertainty interval [UI], 39.8-41.8) deaths per 100 000 population in 1980 to a peak of 55.4 (95% UI, 54.1-56.5) deaths per 100 000 population in 2002 and then declined to 52.9 (95% UI, 51.6-54.4) deaths per 100 000 population in 2014. This overall 29.7%(95% UI, 25.5%-33.8%) increase in chronic respiratory disease mortality from 1980 to 2014 reflected increases in the mortality rate from chronic obstructive pulmonary disease (by 30.8%[95% UI, 25.2%-39.0%], from 34.5 [95% UI, 33.0-35.5] to 45.1 [95% UI, 43.7-46.9] deaths per 100 000 population), interstitial lung disease and pulmonary sarcoidosis (by 100.5%[95% UI, 5.8%-155.2%], from 2.7 [95% UI, 2.3-4.2] to 5.5 [95% UI, 3.5-6.1] deaths per 100 000 population), and all other chronic respiratory diseases (by 42.3%[95% UI, 32.4%-63.8%], from 0.51 [95% UI, 0.48-0.54] to 0.73 [95% UI, 0.69-0.78] deaths per 100 000 population). There were substantial differences in mortality rates and changes in mortality rates over time among counties, and geographic patterns differed by cause. Counties with the highest mortality rates were found primarily in central Appalachia for chronic obstructive pulmonary disease and pneumoconiosis; widely dispersed throughout the Southwest, northern Great Plains, New England, and South Atlantic for interstitial lung disease; along the southern half of the Mississippi River and in Georgia and South Carolina for asthma; and in southern states from Mississippi to South Carolina for other chronic respiratory diseases.CONCLUSIONS AND RELEVANCE Despite recent declines in mortality from chronic respiratory diseases, mortality rates in 2014 remained significantly higher than in 1980. Between 1980 and 2014, there were important differences in mortality rates and changes in mortality by county, sex, and particular chronic respiratory disease type. These estimatesmay be helpful for informing efforts to improve prevention, diagnosis, and treatment.