Identifying the Causes of the Stagnation in National U.S. Cardiovascular Disease Mortality

项目总结 自2010年以来，美国人的预期寿命增长一直停滞不前，在某些年份还出现了下降。大有可为 人们对这一现象的关注集中在药物过量死亡人数上升的作用上。然而，在出版的作品中，我们的 研究小组已确定心血管疾病(CVD)死亡率停滞不前的下降是主要罪魁祸首。一个 未能改善心血管疾病死亡率使美国面临代际寿命持续下降的风险 期望值。然而，到目前为止，研究还没有确定为什么美国心血管疾病死亡率停滞不前，对一些人来说 各年龄段的人数在增加。使用新的方法，我们将研究关于停滞心血管疾病的四个假设 死亡率：(A)国家一级肥胖率上升和由此导致的心血管疾病风险增加；(B)#年持平下降 吸烟，(C)可归因于有心血管病史的人存活率提高的幸存者效应 (D)日益严重的社会经济脆弱性和地域差距。 目标1确定肥胖(目标1a)和吸烟水平(目标1b)的变化所起的作用 有国家级心血管疾病死亡率的数据。我们将重建肥胖的队列历史，以模拟总体情况 包括肥胖持续时间动态在内的现期和早期肥胖的影响 不同时间的人口数量。我们将提供有关经济放缓在卷烟销量下降中的作用的初步估计。 通过将Preston Glei Wilmoth方法扩展到特定原因，吸烟对心血管疾病死亡率趋势的影响 死亡率。我们还将应用g方法来确定肥胖和吸烟的共同影响。 说明了这两个变量之间的动态关系。我们将提供新的估计数字 改变其他三个已确定的心血管危险因素(糖尿病、 高血压、高胆固醇)(目标1c)。目标2调查“生存效应”，即提高存活率 在有中风或心脏病发作病史的人群中， 人口的脆弱性。我们将应用一种新的模拟来量化它的作用。《目标3》将镜头对准了视差 并按地理、种族、出生地和地理位置对近期心血管疾病趋势中的异质性提供了深入的解释 社会经济地位。检查亚群体的异质性将揭示心血管疾病死亡率的模式 与绝望症并驾齐驱。我们将应用目标1和目标2中开发的方法来说明 各人口亚组心血管疾病死亡率水平和趋势的差异。我们还将明确调查 美国不断变化的人口构成在出生和种族/族裔方面的作用。 十年来，美国心血管疾病死亡率下降的停滞现象一直很明显，但没有明确的 解释一下。新冠肺炎的大流行可能只会加剧现有的趋势。鉴于变化的幅度， 心血管疾病的死亡轨迹以及它现在影响到大多数年龄段的美国人的事实表明 不止一个原因造成了这一现象。这个项目将是一个全面而严格的处理 对经济停滞的主要解释。

PROJECT SUMMARY Since 2010, U.S. life expectancy improvements have stalled and in certain years declined. Much attention to this stall has focused on the role of rising drug overdose deaths. In published work, however, our team has identified stagnating declines in cardiovascular disease (CVD) mortality to be the major culprit. A failure to improve CVD mortality puts the U.S. at risk for sustained declines in inter-generational life expectancy. However, to date, research has not identified why U.S. CVD mortality is stagnating and, for some age groups, increasing. Using novel approaches, we will investigate four hypotheses for stagnating CVD mortality: (a) rising obesity and the resulting increase in CVD risk at a national level, (b) plateauing declines in cigarette smoking, (c) survivor effects attributable to improved survival among those with a history of a CVD event, and (d) rising levels of socio-economic vulnerability and geographic disparities. Aim 1 identifies the role that changes in obesity (Aim 1a) and cigarette smoking levels (Aim 1b) are having on national-level CVD mortality. We will reconstruct cohort histories of obesity to model the aggregate effects of both current and earlier-in-life obesity incorporating the dynamics of obesity duration in the population across time. We will provide the first estimates of the role of slowdowns in the decline in cigarette smoking use to CVD mortality trends by extending the Preston Glei Wilmoth approach to cause-specific mortality. We will also apply g-method approaches to identify the joint effects of obesity and smoking accounting for the dynamic relationship between the two variables. We will provide new estimates of the changing prevalence, treatment, and control of three other established CVD risk factors (diabetes, hypertension, high cholesterol) (Aim 1c). Aim 2 investigates “survival effects”, namely that improved survival among those with a history of stroke or a heart attack have accumulated in the population raising the overall frailty of the population. We will apply a novel simulation to quantify its role. Aim 3 turns the lens to disparities and provides an in-depth accounting of heterogeneity in recent CVD trends by geography, race, nativity and socioeconomic status. Examining subpopulation heterogeneity will reveal whether patterns of CVD mortality align with those of diseases of despair. We will apply the methods developed in Aims 1 and 2 to account for disparities in levels and trends in CVD mortality across population subgroups. We will also explicitly investigate the role of the shifting population composition of the United States with respect to nativity and race/ethnicity. The stagnation in U.S. CVD mortality declines has now been evident for a decade without a clear explanation. The COVID-19 pandemic may only worsen existing trends. Given the magnitude of the change in the CVD mortality trajectory and the fact that it is now affecting Americans of most age groups indicates that more than one causal factor is responsible. This project will be a comprehensive and rigorous treatment of leading explanations for the stagnation.