Trends in Ischemic Heart Disease Mortality -- United States, 1980-1988

In 1989, approximately 500,000 persons died from ischemic heart disease (IHD), the leading cause of death in the United States (1). This report summarizes an analysis by CDC to characterize trends in IHD mortality in the United States from 1980 through 1988 (the latest year for which data are available), and emphasizes comparisons by race and sex, region, and state.

Public-use mortality data tapes compiled by CDC's National Center for Health Statistics and population estimates from the Bureau of the Census were used to calculate age-adjusted IHD death rates for persons aged greater than or equal to 35 years, standardized to the 1980 U.S. population. Race-specific denominator data were available only for blacks and whites. IHD deaths were defined as those with the underlying cause of death listed on the death certificate as International Classification of Diseases, Ninth Revision, codes 410-414.

Age-adjusted IHD death rates for the U.S. population aged greater than or equal to 35 years declined 24% -- from 588.3 per 100,000 in 1980 to 448.8 per 100,000 in 1988. Although IHD death rates declined more rapidly for men than for women and for whites than for blacks, they declined for each of the four race-sex groups (Figure 1). The average annual decline (as estimated with a log linear model (2)) was 3.7% for white men, 3.1% for black men, 2.9% for white women, and 2.2% for black women.

During the 9-year period, overall rates of IHD mortality were highest in the Northeast, followed by the Midwest, the South, and the West. IHD death rates declined steadily in each of the four regions of the United States; the average annual decline was 3.9% in the Northeast, 3.2% in the Midwest, 3.1% in the West, and 2.9% in the South. Regional patterns in IHD mortality were similar by race and sex.

IHD death rates for the states varied substantially (Table 1, page 555). For both women and men, there was a more than twofold difference in the 1988 IHD death rate in the state with the highest rate compared with the state with the lowest (women: Hawaii, 184.0 per 100,000 compared with New York, 462.6; men: Hawaii, 316.4 per 100,000 compared with New York, 755.1). To determine whether state-to-state variation in IHD mortality was similar for men and women, the Spearman correlation coefficient was calculated between state-specific rates for women and men. The correlation coefficient was 0.93, indicating that the rank order of states by IHD mortality was similar for women and men.

Throughout the 9-year period, IHD death rates declined in each of the 50 states and the District of Columbia for both women and men (Table 1, page 555). The annual median rate of decline among the states was 3.0% for women and 3.8% for men. However, the percent change in IHD death rates varied widely from state to state for women (range: |m-7.5% to |m-1.3%) and men (range: |m-10.0% to |m-1.9%).

Reported by: Cardiovascular Health Br, Div of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that, for persons aged greater than or equal to 35 years, age-adjusted IHD death rates declined from 1980 through 1988; however, since 1976, the IHD death rates for white men have declined more rapidly (3). The factors contributing to the differential rates of decline are unclear but could include differences in 1) the incidence of coronary heart disease, 2) trends in risk factors for IHD, and 3) access to quality health care.

Although age-adjusted IHD death rates declined faster for men than for women, rates were consistently higher for men. In 1988, the IHD death rate for black men was 1.5 times greater than for black women, and the rate for white men was 1.8 times greater than for white women. These findings are consistent with previous reports noting excess IHD mortality among men and variations in the male-to-female ratio of IHD mortality by race, time period (4), country (5), and age group (6).

The declines in IHD mortality that occurred in all regions and states during 1980-1988 contrast dramatically with increases that occurred from the 1920s through the 1950s (7). The earliest declines in IHD mortality were observed in metropolitan areas, especially in the Northeast and Pacific West, and among communities with the most social and economic resources (8,9). Subsequently, the declines in IHD mortality occurred in nonmetropolitan areas, communities with fewer economic resources, and the southern region. Despite the declines in IHD mortality, death rates still varied substantially by region and state. The strong correlation of state-specific IHD death rates between women and men suggests that there is geographic variation in socioenvironmental conditions that influence the risk for IHD mortality similarly for women and men.

To improve strategies for reducing the burden of IHD mortality among all subgroups of the U.S. population, state-level factors that contribute to the geographic variations in IHD mortality should be identified. For example, the variations may reflect state-to-state differences in factors such as the socioeconomic resources (10), quality and availability of health-care services, and prevalence of risk factors for IHD (e.g., cigarette smoking, dietary patterns, physical activity, hypertension, and hypercholesterolemia).

References

1. NCHS. Advance report of final mortality statistics, 1989. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992. (Monthly vital statistics report; vol 40, no. 8, suppl 2).

2. Kleinman JC. State trends in infant mortality, 1968-1983. Am J Public Health 1986;76:681-7.

3. Sempos C, Cooper R, Kovar MG, McMillen M. Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States. Am J Public Health 1988;78:1422-7.

4. Verbrugge LM. Recent trends in sex mortality differentials in the United States. Women Health 1980;5:17-37.

5. Uemura K, Pisa Z. Recent trends in cardiovascular disease mortality in 27 industrialized countries. World Health Stat Q 1985;38:142-62.

6. Wingard DL, Cohn BA, Kaplan GA, Cirillo PM, Cohen RD. Sex differentials in morbidity and mortality risks examined by age and cause in the same cohort. Am J Epidemiol 1989;130:601-10.

7. Stallones RA. The rise and fall of ischemic heart disease. Sci Am 1980;243:53-9.

8. Wing SB, Casper ML, Riggan W, et al. Socioenvironmental characteristics associated with the onset of decline of ischemic heart disease mortality in the United States. Am J Public Health 1988;78:923-6.

9. Wing SB, Barnett EM, Casper ML, Tyroler HA. Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in white women: empirical findings and theoretical development. Am J Public Health 1992;82:204-9.

10. Wing S, Dargent-Molina P, Casper M, Riggin W, Hayes CG, Tyroler HA. Changing association between community occupational structure and ischemic heart disease mortality in the United States. Lancet 1987;2:1067-70.

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