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Unveiling Disparities in Heart Failure and Cirrhosis Related Mortality: CDC WONDER 1999 to 2020
Saleha Aziz1, Arsalan Hamid2, Anjiya Shaikh3
1University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA. salehaaziz95@gmail.com.
Insights
Mortality in heart failure and cirrhosis patients initially declined but has recently increased, particularly in non-Hispanic American Indians. Targeted interventions are needed to address these concerning trends in vulnerable populations.
Area of Science:
- Public Health
- Epidemiology
- Gerontology
Background:
- Patients with heart failure and cirrhosis face high morbidity and mortality risks.
- Limited data exists on contemporary mortality trends in this vulnerable group based on demographics and geography.
Purpose of the Study:
- To analyze mortality trends in patients with heart failure and cirrhosis from 1999-2020.
- To identify disparities in mortality rates by age, sex, race, ethnicity, and geographic location.
Main Methods:
- Utilized CDC Wide-Ranging OnLine Data for Epidemiologic Research (WONDER) multiple cause of death files (1999-2020).
- Calculated age-adjusted mortality rates (AAMR) and used Joinpoint Trend Analysis Software for annual percentage change (APC).
- Stratified analyses by age, sex, race/ethnicity, location of death, region, state, and rural-urban status.
Main Results:
- Overall AAMR was 2.05 per 100,000; mortality rates showed an initial decline followed by a significant rise from 2009 onwards (APC +12.23 from 2018-2020).
- Non-Hispanic American Indians (NHAI) had the highest AAMR (4.11) with a sharp increase (APC +14.58 from 2013-2020).
- Higher AAMR were observed in males, individuals aged ≥75 years, the South and West regions, West Virginia and Oklahoma, and rural areas.
Conclusions:
- A concerning recent increase in mortality among heart failure and cirrhosis patients is evident.
- Significant disparities exist, with NHAI, males, older adults, and those in rural Southern and Western areas experiencing higher mortality.
- Urgent, targeted interventions are required to improve access to resources, surveillance, and management for this high-risk population.
Background:
Patients with heart failure and cirrhosis are a highly vulnerable population due to increased risk of morbidity and mortality. There is limited evidence on mortality trends by age, sex, race, and geographic location in contemporary years in this vulnerable population.
Methods:
Multiple cause of death files from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research from 1999 to 2020 in age ≥ 25 years were used. Death was presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint Trend Analysis Software was used to determine annual percentage change (APC). These were stratified by age, sex, race and ethnicity, location of death (medical facilities, home, hospice, nursing home), regions (Northeast, Midwest, South, and West), states, and rural-urban areas.
Results:
Total deaths were 98,530 and AAMR was 2.05. The APC from 2001 to 2009 was - 2.80, but from 2009 to 2014 was + 3.16, 2014 to 2018 was + 7.88, and 2018 to 2020 was + 12.23. AAMR were higher in non-Hispanic American Indians (NHAI) (4.11), with a sharp rise in mortality (APC + 14.58, 2013 to 2020). Higher AAMR were observed in the South (2.23) and West (2.24), West Virginia (3.45) and Oklahoma (3.23), rural areas (2.52), males (2.86), and age ≥ 75 years (9.61). Most deaths took place inpatient (48,255).
Conclusion:
There was an initial decline in mortality, however, a rise was observed in recent years. NHAI have the highest AAMR. Higher AAMR are observed in males, in the South and West, and in rural areas. We emphasize the need for targeted interventions addressing these disparities by improving access to resources, surveillance, and management strategies for this vulnerable population.
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