The where of when: Geographic variation in the timing of recent increases in US county-level heart disease death rates

•National declines in heart disease death rates stagnated since 2011.•Heart disease death rates in 44% of US counties began increasing before 2011.•Early increases were found outside of the Northeast and of the most urban centers.•By 2011, more than 20% of adults aged 35–64 years lived in counties w...

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Bibliographic Details
Published in:Annals of epidemiology 2022-08, Vol.72, p.18-24
Main Authors: Vaughan, Adam S., Flynn, Aspen, Casper, Michele
Format: Article
Language:English
Subjects:
Adult
Bayes Theorem
Geography
Heart disease
Heart Diseases
Humans
Mortality
Rural Population
United States - epidemiology
Vital statistics
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Summary:•National declines in heart disease death rates stagnated since 2011.•Heart disease death rates in 44% of US counties began increasing before 2011.•Early increases were found outside of the Northeast and of the most urban centers.•By 2011, more than 20% of adults aged 35–64 years lived in counties with increasing rates.•Spatiotemporal surveillance is key to detecting adverse trends early. Within the context of local increases in US heart disease death rates, we estimated when increasing heart disease death rates began by county among adults aged 35–64 years and characterized geographic variation. We applied Bayesian spatiotemporal models to vital statistics data to estimate the timing (i.e., the year) of increasing county-level heart disease death rates during 1999–2019 among adults aged 35–64 years. To examine geographic variation, we stratified results by US Census region and urban-rural classification. The onset of increasing heart disease death rates among adults aged 35–64 years spanned the two-decade study period from 1999 to 2019. Overall, 43.5% (95% CI: 41.3, 45.6) of counties began increasing before 2011, with early increases more prevalent outside of the most urban counties and outside of the Northeast. Roughly one-in-five (18.4% [95% CI: 15.6, 20.7]) counties continued to decline throughout the study period. This variation suggests that factors associated with these geographic classifications may be critical in establishing the timing of changing trends in heart disease death rates. These results reinforce the importance of spatiotemporal surveillance in the early identification of adverse trends and in informing opportunities for tailored policies and programs.
ISSN:1047-2797
1873-2585
DOI:10.1016/j.annepidem.2022.05.002