Cardiovascular Disease Mortality by County, Race and/or Ethnic Population, United States, 2000-2019

Cardiovascular disease (CVD) remains the leading cause of death and an important contributor to U.S. health disparities.

In this study, the authors sought to assess county-level CVD mortality and trends by race and/or ethnicity as well as by detailed CVD cause of death.

We estimated age-standardized mortality rates (ASMRs) for 5 racial and/or ethnic groups (American Indian or Alaska Native [AIAN], Asian or Pacific Islander [Asian], Black or African American [Black], Hispanic or Latino [Latino], and White), 3,110 counties, 21 causes of CVD death, and 20 years (2000-2019) using small-area estimation methods and death certificate data from the U.S. National Vital Statistics System. Estimated mortality rates were adjusted for misreporting of race or ethnicity on death certificates and age-standardized to the 2010 census. Counties were classified into persistently high mortality, persistently low mortality, and intermediate strata based on age-adjusted CVD mortality rates, stratified by race and/or ethnicity.

The ASMR for total CVD was 237.8 (95% uncertainty interval: 237.2-238.4) deaths per 100,000 in 2019. Mortality was highest for the Black population for total CVD and 12 of 17 detailed CVD causes, and lowest for the Asian population for total CVD and 13 of 17 detailed causes. From 2000 to 2019, mortality declined for total CVD and 12 of 17 detailed causes; however, mortality increased for 3 detailed causes. Mortality also varied widely among counties-much more than among states-both within and among racial and/or ethnic populations. Spatial mortality patterns varied considerably by CVD cause and by race and/or ethnicity.

While declining CVD mortality reflects meaningful clinical and public health progress, persistent and pervasive disparities demand solutions-oriented, place-informed research to drive further progress. Critically, these pre-Covid data establish a baseline essential for isolating Covid-era-attributable shifts from preexisting trends. These granular county-level data stratified by CVD cause, race, and/or ethnicity offer a scalable, repeatable framework for agencies to tailor health interventions and rigorously track disparities over time.