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Cardiovascular Mortality Gap Between the United States and Other High Life Expectancy Countries in 2000-2016
Enrique Acosta1, Neil Mehta2, Mikko Myrskylä1,3
1Max Planck Institute for Demographic Research, Rostock, Germany.
Insights
Cardiovascular disease (CVD) mortality in the U.S. has stagnated more than in other high life expectancy countries. This divergence is linked to slowing reductions in ischemic heart disease and stroke, and rising deaths from other CVD causes, possibly due to obesity and alcohol.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Medicine
Background:
- Cardiovascular disease (CVD) mortality reductions have stalled in the United States, a trend that began earlier and is more pronounced than in other high life expectancy countries (HLCs).
- The reasons behind this stagnation in U.S. CVD mortality are not well understood, necessitating cross-national comparative analysis.
Purpose of the Study:
- To quantify the exceptionality of U.S. cardiovascular disease mortality trends compared to other HLCs.
- To investigate the underlying causes of the U.S. CVD mortality stall by examining trends in specific CVD subclassifications and related behavioral factors.
Main Methods:
- Analysis of World Health Organization data (2000-2016) for the United States and 17 HLCs.
- Quantification of CVD mortality differences and trends, decomposed by major CVD subclassifications (ischemic heart disease, stroke, other heart diseases).
- Comparison of CVD mortality trends with mortality trends related to obesity, smoking, alcohol, and drugs.
Main Results:
- U.S. CVD mortality is higher than the HLC average, with the gap widening after 2008.
- The divergence is primarily driven by slowing reductions in ischemic heart disease and stroke mortality, alongside increasing mortality from other CVD causes.
- Mortality trends related to obesity and alcohol abuse show temporal patterns similar to cardiovascular mortality.
Conclusions:
- The U.S. exhibits exceptional cardiovascular disease mortality trends, characterized by decelerating progress in ischemic heart disease and stroke, and worsening outcomes in other CVD categories.
- Obesity and alcohol abuse emerge as potential interrelated factors contributing to the distinct U.S. CVD mortality pattern.
Objectives:
Reductions in U.S. cardiovascular disease (CVD) mortality have stagnated. While other high life expectancy countries (HLCs) have also recently experienced a stall, the stagnation in CVD mortality in the United States appeared earlier and has been more pronounced. The reasons for the stall are unknown. We analyze cross-national variations in mortality trends to quantify the U.S. exceptionality and provide insight into its underlying causes.
Methods:
Data are from the World Health Organization (2000-2016). We quantified differences in levels and trends of CVD mortality between the United States and 17 other HLCs. We decomposed differences to identify the individual contributions of major CVD subclassifications (ischemic heart disease [IHD], stroke, other heart diseases). To identify potential behavioral explanations, we compared trends in CVD mortality with trends in other causes of death related to obesity, smoking, alcohol, and drugs.
Results:
Our study has four central findings: (a) U.S. CVD mortality is consistently higher than the average of other HLCs; (b) the U.S.-HLC gap declined until around 2008 and increased thereafter; (c) the shift from convergence to divergence was mainly driven by slowing IHD and stroke mortality reductions and increasing mortality from other CVD causes; (d) among the potential risk factors, only obesity- and alcohol-related mortality showed age-specific temporal changes that are similar to those observed for cardiovascular mortality.
Discussion:
The exceptional changes in U.S. CVD mortality are driven by a distinct pattern of slowing reductions in IHD and stroke mortality and deteriorating mortality from other CVD causes. Obesity and alcohol abuse appear to be interrelated factors.
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