Clinical Research Study
Comparative Trends in Heart Disease, Stroke, and All-Cause Mortality in the United States and a Large Integrated Healthcare Delivery System

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Abstract

Objectives

Heart disease and stroke remain among the leading causes of death nationally. We examined whether differences in recent trends in heart disease, stroke, and total mortality exist in the United States and Kaiser Permanente Northern California (KPNC), a large integrated healthcare delivery system.

Methods

The main outcome measures were comparisons of US and KPNC total, age-specific, and sex-specific changes from 2000 to 2015 in mortality rates from heart disease, coronary heart disease, stroke, and all causes. The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research data system was used to determine US mortality rates. Mortality rates for KPNC were determined from health system, Social Security vital status, and state death certificate databases.

Results

Declines in age-adjusted mortality rates were noted in KPNC and the United States for heart disease (36.3% in KPNC vs 34.6% in the United States), coronary heart disease (51.0% vs 47.9%), stroke (45.5% vs 38.2%), and all-cause mortality (16.8% vs 15.6%). However, steeper declines were noted in KPNC than the United States among those aged 45 to 65 years for heart disease (48.3% KPNC vs 23.6% United States), coronary heart disease (55.6% vs 35.9%), stroke (55.8% vs 26.0%), and all-cause mortality (31.5% vs 9.1%). Sex-specific changes were generally similar.

Conclusions

Despite significant declines in heart disease and stroke mortality, there remains an improvement gap nationally among those aged less than 65 years when compared with a large integrated healthcare delivery system. Interventions to improve cardiovascular mortality in the vulnerable middle-aged population may play a key role in closing this gap.

Section snippets

Methods

The US national mortality rates for 2000-2015 were ascertained using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research data set. This data set includes the assigned cause of death from all death certificates filed in the 50 states and the District of Columbia.8 Categorization of the presumed underlying cause of death used International Statistical Classification of Diseases and Related Health Problems, Tenth Edition (ICD-10) codes as follows:

Results

The age-adjusted rates for all mortality end points were higher in 2000 in the United States than in KPNC (Table 1A and B), except stroke, for which the rates were nearly identical in 2000 (heart disease 39.3%, coronary heart disease 37.4%, all-cause 27.5% higher in the United States than in the KPNC, whereas stroke mortality was 0.2% lower). The percentage gaps increased from 2000 to 2015 so that they were 43.2%, 45.7%, 13.3%, and 29.4% higher for heart disease, coronary heart disease, stroke,

Discussion

Compared with the US population, mortality rates and the 15-year percent decline in mortality rates attributed to heart disease, coronary heart disease, and stroke were greater in a large integrated healthcare delivery system. Furthermore, the percent decline was substantially greater for the young (<45 years) and at-risk middle-age (45-64 years) population. However, given the much higher absolute rates of cardiovascular mortality in middle-aged compared with younger adults, the gap observed

Acknowledgments

The authors thank Karin Winter for assistance in manuscript preparation.

References (17)

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Funding: This study was conducted within the Cardiovascular Research Network, a consortium of research organizations initially sponsored by the National Heart Lung and Blood Institute (NHLBI) (U19 HL91179-01 and RC2 HL101666) and the American Recovery and Reinvestment Act of 2009 (ARRA).

Conflicts of Interest: SS reports grants from the National Heart, Lung, and Blood Institute, and National Institute of Neurological Disorders and Stroke during the conduct of the study. ASG reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. MNN-H reports grants from the National Institute of Neurological Disorders and Stroke, outside the submitted work.

Authorship: All authors had access to the data and played a role in writing this manuscript.

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