Impact of Interventions on Future Trends in Subnational Burden of Cardiovascular Diseases in the US

项目总结 心血管疾病(CVD)的地理和种族/民族差异--是 美国-保持规模较大。自2010年以来，许多州的心血管疾病死亡率不再下降，对一些州来说 群体中，死亡率正在上升。减少心血管疾病差距是美国卫生政策的主要目标，但 国家级战略，如健康人2020和百万心脏运动，不会直接 解决州与州之间心血管疾病的巨大地理差异。美国拥有丰富的地方健康数据，但它 整合得很差，所以几乎没有证据来指导各州或地方卫生系统在选择 在初级预防干预措施和政策中。卫生政策模型是整合 风险暴露和疾病负担的复杂模式与其他人口趋势，包括收入， 教育、老龄化、移民和医疗保健服务。之前的心血管疾病预测和政策模型 只产生了单一的地理估计--主要是国家估计，这不能提供所需的证据 解决地理差异问题。这项研究的首要目标将是：系统分析为什么会发生心血管疾病 美国的模式因年龄、性别、种族/民族和州而不同；这种差异将如何导致未来的差异 心血管疾病死亡率；以及类似的风险降低策略对不同 美国各州。在这项工作中，我们将采用计量经济学、地理空间和流行病学建模方法 利用全球疾病负担研究的大量数据和计算资源。目标1是一种心血管疾病 人口健康预测，将按年龄、性别和年龄估计美国各州未来的心血管疾病负担 种族/民族。利用观察到的心血管疾病的过去趋势和主要的可改变的因果风险因素，我们将预测 美国各州到2040年因心血管疾病造成的健康损失，包括伤残调整寿命年(DALY)。我们 将现有健康监测数据的多个来源与州一级健康结果相结合 考试调查。估计数将按性别和5岁年龄组分开计算，共四个 关于心血管疾病的详尽种族/民族分类，以及分别针对缺血性心脏病、心力衰竭、 中风、外周血管疾病、主动脉瘤和慢性肾脏疾病。目标2是一套新的心血管疾病 卫生政策模型，评估每个州的干预措施对改善提供情况的影响 降低血压和低密度脂蛋白-胆固醇的药物疗法。目标3是一套新的心血管疾病健康政策 评估行为干预影响的模型显示可减少心血管疾病风险因素。投影和 心血管疾病的政策模型是缩小美国健康差距的必要步骤。我们的结果将能够 指导地方决策者考虑一系列政策选择，以减轻心血管疾病的负担。到时候我们会的 实施广泛的传播计划，旨在将我们工作的影响扩大到学术之外 受众，提供网络研讨会、政策报告以及与卫生部门和其他利益攸关方的接触 积极投身重点州政策工作。

PROJECT SUMMARY Geographic and racial/ethnic disparities in cardiovascular diseases (CVD) – the leading cause of death in the U.S. – remain large. Since 2010, CVD death rates are no longer declining in many states, and for some groups, mortality is increasing. Reduction in CVD disparities is a major stated goal of U.S. health policy, but national-level strategies, such as Healthy People 2020 and the Million Hearts campaign, do not directly address these large geographic differences in CVD between states. The U.S. is rich in local health data, yet it is poorly integrated, so there is little evidence available to guide states or local health systems when selecting among primary prevention interventions and policies. Health policy models are an important way to integrate complex patterns of risk exposure and disease burden with other population trends including income, education, aging, migration, and health care access. Previous CVD forecasts and policy models have produced only single geography – primarily national – estimates, which cannot provide the evidence needed to address geographic disparities. The overarching goal for this study will be: a systematic analysis of why CVD patterns vary by age, sex, race/ethnicity, and state in the U.S.; how this variation will lead to future divergence in CVD mortality rates; and the variable impact that similar risk reduction strategies will then have on different U.S. states. For this work, we will adapt econometric, geospatial, and epidemiologic modelling methods by leveraging the large data and computational resources of the Global Burden of Disease Study. Aim 1 is a CVD population health projection that will estimate future burden of CVD for each U.S. state by age, sex, and race/ethnicity. Using observed past trends in CVD and major modifiable causal risk factors, we will project health loss due to CVD, including disability-adjusted life years (DALYs), through 2040 for each U.S. state. We will integrate multiple sources of existing health surveillance data with the results of state-level health examination surveys. Estimates will be produced separately by sex and 5-year age groups, for four collectively exhaustive race/ethnicity categories for CVD overall, and separately for ischemic heart disease, heart failure, stroke, peripheral vascular disease, aortic aneurysm, and chronic kidney disease. Aim 2 is a new set of CVD health policy models that estimate the impact within each state of interventions shown to improve the delivery of pharmacotherapies that lower blood pressure and LDL-cholesterol. Aim 3 is a new set of CVD health policy models that estimate the impact of behavioral interventions shown to reduce CVD risk factors. Projections and policy models for CVD are a necessary step in reducing U.S. health disparities. Our results will be able to guide local decision-makers considering a range of policy options to reduce the burden of CVD. We will then implement a broad dissemination plan designed to expand the impact of our work beyond academic audiences, providing webinars, policy reports, and outreach to health departments and other stakeholders actively engaged in policy work in key states.