Abstract MP047: Early-Onset Coronary Heart Disease Mortality Remains High Among Rural Blacks

Abstract

Background: Deaths from early-onset coronary heart disease (CHD) translate into a large number of potential life-years lost with substantial impact on families and society. Although overall CHD mortality has declined in the past few decades, the extent to which such decline applies to early CHD mortality and to specific racial groups and urbanization levels has not been examined. We sought to describe the pattern and magnitude of racial and urban-rural variations in early-onset CHD mortality in the United States. Methods: We used data from the National Center for Health Statistics to examine trends in CHD death rates (ICD-10 codes I20-I25) between 1999 and 2007. Early-onset CHD mortality was defined as death due to CHD in men less than 55 yrs or women less than 65 yrs. Rate changes were calculated in the overall population and by race (blacks vs whites) and urbanization (rural vs. urban). Poisson regression was used to model the data. Results: Between 1999 and 2007, there were approximately 400,000 deaths due to early-onset CHD. There was an overall 25% decline in age-adjusted early-onset CHD mortality rates from 79 per 100,000 to 59 per 100,000 but this decline varied by gender, race, and urbanization. Women had a greater decline (27%) compared with men (19%) and blacks had slightly more decline (27%) compared to whites (25%). Urban areas (30%) had twice the decline compared to rural areas (16%). In this period early CHD deaths was higher in blacks than whites and higher in rural than urban areas (Figure). Blacks in rural areas had the highest early-onset CHD mortality, followed by blacks in large metros, while urban whites had the lowest rate. Black-white differences remained similar in urban and rural areas over this time period. Conclusion: The overall decline in early-onset CHD mortality is encouraging, but there are important differences by race and urbanization. Blacks in rural areas have the highest early-onset CHD mortality rates. Early-onset CHD can be used to identify and target groups with high risk in order to reduce disparities.