Abstract MP08: Evaluating the Influence of Bloomberg Era Policy on New York City Cardiovascular Disease Mortality Rates

Abstract

Background: Since 2002, under the Bloomberg administration, New York City (NYC) has aggressively pursued and implemented a broad set of public health policies to reduce chronic disease. Limited research exists evaluating secular trends in cardiovascular disease (CVD) mortality against the backdrop of these policy initiatives. Hypothesis: We hypothesized that CVD mortality trends declined more rapidly during the years 2002-2011 compared with the previous decade. Methods: Using individual death certificates of NYC residents during 1990-2011, all-cause mortality rates were calculated in addition to the following cause-specific mortality rates: any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), stroke, ischemic stroke. Mortality rates were age and sex standardized to the NYC year 2000 population. Joinpoint regression identified years in which mortality trends changed after excluding 116,285 deaths (10% of all deaths) occurring in 9 NYC hospitals (due to their participation in a cause of death reporting quality improvement training in 2009, sponsored by NYC Department of Health & Mental Hygiene (DOHMH)). Results: 1,149,217 deaths occurred to NYC residents from 1990-2011, 566,181 among women and 583,036 among men. The annual percent change (APC) in all-cause mortality rates for women and men were -2.6% and -7.1% between 1994 and 1998, while rates were approximately -2.5% for both sexes from 1998-2011. CVD accounted 49.5% and 37.5% of deaths among women and men, respectively in 1990; in 2011 these proportions were 40.4% and 35.3%. Age standardized CVD mortality rates (per 100,000) for women and men were 391.0 and 357.8 in 1990 vs. 197.2 and 166.2 in 2011. Overall CVD mortality rates increased in women and men by 1.7% and 0.05% from 1990-1993 and began to decline in 1993 with APCs of -3.8% and -4.0% during 1993-2011. In contrast, the decline in atherosclerotic CVD mortality accelerated during 2002-2011 (APC=-4.7%) vs. 1990-2002 (APC=-2.4%) among men. Among women, atherosclerotic CVD rates began to decline more rapidly in 1993 (APC=-3.2%) and again in 2006 (APC=-6.6%) vs. 1990-1993 (APC=1.9%). Similar trends were evident for CAD mortality. Ischemic stroke mortality rates declined steadily from 1990-2011 in both sexes and there was no evidence of change in these trends. Results were generally consistent when all hospitals were included with the exception of rates for overall CVD mortality, which began to show more rapid decline in 2009 - immediately following DOHMH cause-of-death training efforts. Conclusion: Overall, CVD mortality rates in NYC did not accelerate during the 2002-2011 period after accounting for changes in cause of death reporting. However, atherosclerotic CVD rates did appear to change in slope (shift to declining more rapidly) during this period, with possible differences in timing between men and women.