2 tables, 1 figure omitted
In 2001, heart disease accounted for approximately 29.0% of deaths among
U.S. residents; 16.8% of those deaths occurred among persons aged <65 years.1 Although mortality rates from heart disease have
decreased, the decline has not been uniform for all populations.2 One
of the two overall national health objectives for 2010 is to eliminate health
disparities among different segments of the U.S. population.3 To
better understand these disparities, CDC analyzed death certificate data for
premature deaths from heart disease occurring in 2001. This report summarizes
the results of that analysis, which indicated that the proportion of premature
heart disease deaths varied by state and was higher among blacks, American
Indians/Alaska Natives (AI/ANs), Asians/Pacific Islanders (A/PIs), and Hispanics.
Reducing premature death from heart disease and eliminating disparities will
require preventing, detecting, treating, and controlling risk factors for
heart disease in young and middle-aged adults.
Death certificate data from the 50 states and the District of Columbia
(DC) were obtained from the National Center for Health Statistics. Demographic
data (e.g., age and race/ethnicity) on death certificates were reported by
funeral directors or provided by family members. Heart disease–related
deaths were defined as those for which the underlying causes listed on death
certificates by a physician or coroner were International
Classification of Diseases, Tenth Revision (ICD-10), codes I00–I09,
I11, I13, or I20–I51. Premature deaths were defined as those occurring
among persons aged <65 years. Proportions of premature death were calculated
for all 50 states and DC.
During 2001, of 700,142 deaths attributed to heart disease, 117,346
(16.8%) occurred among persons aged <65 years. The proportion of premature
deaths was greatest among AI/ANs (36.0%) and blacks (31.5%) and lowest among
whites (14.7%). Premature death was higher for Hispanics (23.5%) than non-Hispanics
(16.5%), and for males (24.0%) than females (10.0%). Hispanic whites (23.3%)
had lower proportions than Hispanic blacks (27.5%), and non-Hispanic whites
had lower proportions (14.4%) than non-Hispanic blacks (31.5%). The highest
proportions of all deaths occurred among persons aged 55-64 years. When premature
death was examined by age-specific death rate, mortality increased with age,
and rates across all age groups were highest among blacks and lowest among
The proportions of premature heart disease deaths ranged from 12.4%
in Rhode Island to 35.7% in Alaska. The 10 areas with the highest proportions
were Alaska (35.7%), Nevada (25.4%), Georgia (23.9%), South Carolina (23.8%),
Louisiana (22.9%), DC (21.5%), Alabama (21.4%), Tennessee (21.3%), Mississippi
(20.7%), and Texas (20.5%). Among males, proportions were highest in Alaska
(41.8%) and lowest in North Dakota (18.6%); among females, proportions were
highest in Alaska (26.0%) and lowest in South Dakota (6.3%). Within states/areas,
racial/ethnic differences in premature death were similar to those observed
SS Oh, MPH, JB Croft, PhD, KJ Greenlund, PhD, C Ayala, PhD, ZJ Zheng,
MD, GA Mensah, MD, WH Giles, MD, Div of Adult and Community Health, National
Center for Chronic Disease Prevention and Health Promotion, CDC.
In 2001, approximately 17% of all deaths from heart disease occurred
among persons aged <65 years; these deaths occurred disproportionately
among certain racial/ethnic minority populations, and demographic and geographic
disparities also persisted. The determinants of these disparities are not
clear. Differences by sex might be attributed in part to the cardioprotective
effects of estrogen in pre- and perimenopausal women.4 Specific
racial/ethnic variations might reflect differences in demographics, risk factors
for heart disease, access to medical and emergency care, or other factors.
For example, in the United States, the prevalence of obesity and diabetes
is higher for blacks and AI/ANs than whites.5 The
prevalence of cigarette smoking for AI/ANs is nearly double that for whites.5 Blacks have a higher prevalence of high blood pressure
than whites,5- 7 and
Hispanics are less likely than whites to have their blood pressure checked,6 to be aware of having high blood pressure,7 or to be treated and controlled for high blood
pressure.7 In the United States, greater
proportions of blacks, Hispanics, and AI/ANs than whites lack health-care
coverage and cite cost as a barrier to obtaining health care.5
State variations probably reflect differences in demographics, lifestyles,
and risk factors. Among the 10 areas with the highest proportions of premature
death, those in the southeast also have high prevalence of high blood pressure,6 smoking, physical inactivity, and obesity.8 These risk factors are not as prevalent in DC and
Hawaii, which suggests that other risk factors (e.g., dietary factors and
elevated serum cholesterol) might be more dominant causes of premature death
in those areas.
The findings in this report are subject to at least two limitations.
First, underlying cause of death data are subject to errors in the certification
of cause of death. Second, racial/ethnic populations have different proportions
of persons at younger ages,9 which might
account for the different proportions of premature deaths. In 2001, approximately
86% of non-Hispanic whites were aged <65 years, compared with 92% of non-Hispanic
blacks, 94% of AI/ANs, 92% of A/PIs, and 95% of Hispanics.1 Although
death rates vary by race/ethnicity, heart disease is the leading cause of
death for all racial/ethnic minority populations except A/PIs, for which it
is the second leading cause of death.9
Risk factors for heart disease include high blood pressure, elevated
serum cholesterol levels, smoking, diabetes, physical inactivity, and obesity.
Premature death from heart disease can be reduced by preventing or treating
these risk factors. Public health professionals should focus efforts on prevention
and risk reduction at all ages, and particularly at younger ages among racial/ethnic
minorities. Further analysis of state data should be conducted to identify
county-level disparities, which might aid public health agencies in allocating
resources more effectively. The proportion of deaths among persons aged <65
years and the high prevalence of the major risk factors in the general population
underscore the need for aggressive public health efforts. Improved health
promotion and primary and secondary prevention strategies are needed to decrease
the burden of heart disease and eliminate health disparities in the population.
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