Abstract 19: State-level Disparities in Health Loss Due to Cardiovascular Causes: Results of the Global Burden of Disease 2015 Study

Abstract

Introduction: Reducing cardiovascular (CVD) health disparities is a major policy goal in the United States but comprehensive and comparable estimates of CVD disease burden do not exist. The GBD2015 study developed a method to estimate disability-adjusted life-years (DALYs) lost to CVD for each state. Hypothesis: We assessed the hypothesis that health loss due to CVD is no longer declining in the United States. Methods: We used death certificates, health surveys, commercial databases, and published literature to estimate CVD death rate and prevalence. Our analyses corrected for use of non-specific causes of death, readmission rates, and variation in the use of ICD codes. Models were run separately by age, sex, state, cause, and year. Disability weights were derived from large-scale surveys of the public. Uncertainty intervals (UI) were estimated using 1000 draws from the posterior distribution of each model. Results: In the U.S. in 2015, 13.63 million DALYs were lost due to CVD (95% UI 13.1-14.2), which accounted for 15.4% (95% UI 14.1-16.9%) of total DALYs for the United States. From 1990-2015, the annualized rate of change for CVD DALYs (per 100,000 persons) was -1.2%, but for 2010-2015, this rate was 0.5%. The smallest annualized rate of change for CVD DALYs (per 100,000, age-standardized) from 1990-2015 was observed in Oklahoma (-1.1%) while the largest change was in New York (-2.6%). For only 2010-2015, this rate declined in most states but increased in Idaho, Indiana, Mississippi, and Maine by 0.02-0.47%. Ischemic heart disease was the predominant cause of health loss for all states. Conclusions: The decline in CVD burden has slowed in all states, with rates rising in several states. Further efforts are needed to understand state-level factors influence changing rates of CVD burden.