Trends in cardiovascular mortality across U.S. counties have changed significantly from 1980 to 2014, and there are substantial variations across counties for ischemic disease and stroke mortality rates, according to a study published May 16 in the Journal of the American Medical Association.

Gregory A. Roth, MD, MPH, FACC, et al., looked at deidentified death records from the National Center for Health Statistics and population records from the U.S. Census Bureau, the National Center for Health Statistics and the Human Mortality Database from 1980 to 2014.

Researchers found that cardiovascular disease is still the leading cause of death in the U.S., although mortality rates dropped 50.2 percent between 1980 and 2014. In 2014, cardiovascular disease was the cause of more than 846,000 deaths and 11.7 million years of life lost. Between 1980 and 2014, the difference in cardiovascular mortality rates between counties at the 10th and 90th percentile (accounting for population age differences) dropped 14.6 percent (from 172.1 to 147.0 deaths per 100,000 persons).

In 2014, counties in the 90th percentile for ischemic heart disease mortalities had twice as many deaths as counties in the 10th percentile. Counties in the 90th percentile for cerebrovascular disease mortalities had 1.7 times as many deaths as counties in the 10th percentile. For other cardiovascular disease causes, the ratio of deaths in 90th percentile counties to deaths in 10th percentile counties ranged from 1.4 (aortic aneurysm) to 4.2 (hypertensive heart disease).

The greatest concentration of counties with high cardiovascular disease mortality in 2014 spanned southeastern Oklahoma along the Mississippi River Valley, to eastern Kentucky. However, specific cardiovascular disease conditions were clustered elsewhere, including atrial fibrillation in the Northwest, aortic aneurysm in the Midwest and endocarditis in the Mountain West and Alaska. Counties with lower cardiovascular mortality rates were found around San Francisco, California, central Colorado, northern Nebraska, central Minnesota, northeastern Virginia and southern Florida.

The authors conclude that patterns and trends in cardiovascular mortality variations across U.S. counties have health policy implications on the local and national level. They add that moving forward, "major efforts are still needed to reduce geographic variation in risk of death due to ischemic heart disease and cerebrovascular diseases."

In a related editorial comment, George A. Mensah, MD, FACC; David C. Goff, MD, PhD; and Gary H. Gibbons, MD, add that "these state-based, county-level variations are important because understanding their primary determinants can inform not only the types of multilevel and multisector interventions needed but also the level of intensity and the necessary dose required for practices, programs, and policies to have sustained beneficial effects on health."

Keywords: Alaska, American Medical Association, Aortic Aneurysm, Atrial Fibrillation, California, Cause of Death, Censuses, Cerebrovascular Disorders, Colorado, Coronary Artery Disease, Death Certificates, Endocarditis, Florida, Health Policy, Hylobates, Kentucky, Minnesota, Mississippi, Myocardial Ischemia, National Center for Health Statistics, U.S., Nebraska, Oklahoma, Research Personnel, San Francisco, Stroke, Virginia

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