Abstract 076: Longitudinal Trajectories And Predictors Of County-level Cardiovascular Mortality In The United States (1980-2014)

Abstract

Introduction: CV mortality has declined over 4 decades in the U.S. However, whether declines have been uniformly experienced across U.S. counties, and predictors of CV mortality trajectory are not known. Methods: County-level mortality data from 1980-2014 was obtained from the National Center for Health Statistics. We used a ClustMix approach to identify 3 distinct county phenogroups based on mortality trajectory. Adjusted multinomial logistic regression models were constructed to evaluate the associations between county-level characteristics (demographic, social, and health status) and CV mortality trajectory-based phenogroups. Results: Among 3,133 counties, there were parallel declines in CV mortality in all groups (Fig.1A). High-mortality counties were located in the South and parts of the Ohio and Mississippi River valleys (Fig. 1B). County phenogroups varied significantly in social characteristics such as non-white proportion (low vs. high mortality: 12% vs. 27%), high-school education (11% vs. 20%), and violent crime rates (.01 vs. 0.3/100 population). Disparities in health factors were also observed with higher rates of smoking, obesity, and diabetes in the high (vs. low) mortality groups. A substantial collinearity was observed between social and health factors. In adjusted analysis, social, environmental, and health characteristics explained 56% variance in the county-level CV mortality trajectory. Education status (OR [95% CI]=12.4 [9.4-16.3]), violent crime rates (OR [95% CI] =1.6 [1.3-1.9]), and smoking (OR [95% CI] = 3.9 [3.1- 4.9]) were the strongest predictors of high mortality trajectory phenogroup membership (ref: low mortality). Conclusions: Despite a decline in CV mortality, disparities at the county-level have persisted over the past 4 decades largely driven by differences in social characteristics and smoking prevalence. This highlights the need for multi-domain interventions focusing on safety, education and public health to improve county-level disparities in CV health.