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

项目摘要 自2010年以来，美国人的预期寿命一直停滞不前，在某些年份甚至有所下降。多 对这一停滞的关注集中在药物过量死亡人数上升的作用上。在出版的作品中，我们 研究小组已经确定，心血管疾病（CVD）死亡率的停滞下降是罪魁祸首。一 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 期待然而，到目前为止，研究还没有确定为什么美国CVD死亡率停滞不前， 年龄组，增长。使用新的方法，我们将调查四个假设停滞心血管疾病 死亡率：（a）在全国范围内，肥胖率上升，导致心血管疾病风险增加，（B） 吸烟，（c）在有CVD病史的患者中，归因于生存率提高的生存效应 （d）社会经济脆弱性和地域差距不断扩大。 目标1确定了肥胖（目标1a）和吸烟水平（目标1b）的变化在 在全国范围内的CVD死亡率。我们将重建肥胖的队列历史， 目前和早期肥胖的影响，包括肥胖持续时间的动态， 人口跨越时间。我们将提供第一个估计的作用放缓下降的香烟 通过将普雷斯顿格雷威尔莫斯的方法扩展到病因特异性， mortality.我们还将应用g方法来确定肥胖和吸烟的联合影响 考虑到两个变量之间的动态关系。我们将提供新的估计， 改变患病率、治疗和控制其他三个已确定的CVD风险因素（糖尿病， 高血压、高胆固醇）（目标1c）。目标2调查“生存效应”，即提高生存率 在那些有中风或心脏病发作史的人中， 人口的脆弱。我们将应用一种新的模拟来量化它的作用。目标3将透镜变为视差 并提供了一个深入的解释异质性，在最近的CVD趋势的地理，种族，出生地和 社会经济地位。检查亚群异质性将揭示CVD死亡率的模式是否 与那些绝望的疾病相一致。我们将采用目标1和2中制定的方法， 不同人群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 美国人口组成的变化在出生和种族/民族方面的作用。 美国心血管疾病死亡率下降的停滞已经明显十年了，没有明确的 解释COVID-19疫情可能只会使现有趋势恶化。考虑到 心血管疾病死亡率的轨迹以及它现在影响大多数年龄组的美国人的事实表明， 原因不止一个。该项目将是一个全面和严格的治疗， 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.