Very concerning" and persistent racial disparities seen in population-based study
Long-running trends toward improved survival for patients with diabetes, stroke, and heart disease essentially stalled in the past decade, researchers found, while deaths related to hypertension continued their climb extending back to at least 1999.
Age-adjusted mortality rates (AAMRs) per 100,000 people decreased from 1999 to 2017 for the following conditions, reported Sadiya Khan, MD, MSc, of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues:
- Heart disease: from 266.5 to 165.0
- Stroke: from 61.6 to 37.6
- Diabetes: from 25.0 to 21.5
But nearly all that progress occurred during the period ending in 2010, the researchers noted in a JAMA research letter, with very little change during 2011-2017. And for hypertension, the AAMR increased from 6.2 to 9.0 per 100,000 people across the entire 19-year study period.
Moreover, the stagnation or worsening in death rates were seen in whites as well as blacks, and in men as well as women.
Data for the study came from death certificate information in the CDC's Wide-Ranging Online Data for Epidemiologic Research (WONDER) database, covering all U.S. deaths from 1999 to 2017. Khan and colleagues focused on deaths from cardiometabolic diseases including stroke, essential hypertension and hypertensive renal disease, heart disease, and diabetes. Age-adjusted death rates were assessed overall and stratified by race (black vs white) and sex. The data covered about 977,000 total deaths in 1999; the yearly count fell slowly over time to reach 912,000 in 2017.
Notably, black individuals had consistently greater AAMRs across disease types. In 2017, the greatest mortality rates were related to hypertension in black versus white men (rate ratio 2.18), and for diabetes in black versus white women (rate ratio 2.09), the authors added. Rate ratios for black versus white individuals for the other causes of death also all indicated greater mortality in blacks, ranging from 1.24 (heart disease in men) to 1.97 (hypertension in women).
"The fact that since 1999 the difference in death rates for black Americans compared to white Americans continued to persist despite the advances that we've made is very concerning," Khan told MedPage Today.
Death due to diabetes, stroke, heart disease, and hypertension are largely preventable, and so both for providers and patients, focusing on prevention earlier in the life course is likely to be an effective approach, Khan highlighted. "Identifying those at risk, trying to prevent the development of risk factors, and engaging in heart healthy behaviors are important."
"Clinical and public health efforts focusing on primordial and primary prevention throughout the life course, with an emphasis on identifying and addressing the causes of racial disparities, are needed to reverse the slowing of cardiometabolic mortality rate declines," the authors wrote.
A limitation of the study was use of death certificate information, which may have led to miscoding. Khan and colleagues also admitted that this information did not identify if adjustments in AAMRs are the result of changing case-fatality rates or disease incidence.
The study is funded by the National Institutes of Health (NIH) National Center for Advancing Translational Sciences.
Khan reported no disclosures.
Source Reference: Shah NS, et al "Trends in cardiometabolic mortality in the United States, 1999-2017" JAMA 2019; DOI: 10.1001/jama.2019.9161.
Read the original article on Medpage Today: Progress Against Cardiometabolic Death Stalls in U.S.