Ethnic And Racial Disparities In Heart Failure Related Mortality Rates Among Older Adults; Data From CDC Wonder 1999-2019

Abstract

Background Heart failure majorly effects the elderly and accounts for significant morbidity and mortality. Important disparities in heart failure patients persist based on their racial/ethnic status. With the increase in ageing population, we aimed to study the trends in heart failure related deaths in elderly population stratified on race/ethnicity in the United States from 1999 to 2019. Methods : We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. Heart failure related deaths in elderly (defined as age >/= 75 years) were identified using the International Classification of Diseases, Tenth Revision, codes from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC) in heart failure related deaths overall and stratified by racial/ethnic groups (non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), Hispanics, non-Hispanic Asian or Pacific Islanders (NH-APIs) and non-Hispanic American Indian or Alaska Natives (NH-AIANs). Results AAMR related to heart failure in elderly decreased from 1409.97 per 100,000 in 1999 to 1082.67 per 100,000 in 2012 (APC -2.1 [95% CI, −2.4 to −1.9]) and then increased to 1209.56 per 100,000 in 2019 (APC 1.7 [95% CI, 1.1 to [95% CI, −2.4 to −1.92.3]). Among the racial/ethnic groups, AAMR was highest in NHWs (1271.51) followed by NHBs (1086.59), NH-AIANs (1019.8), Hispanics (780.45) and lastly NH-APIs (570.99). AAMR continued to decrease throughout the study period from 1999-2018 in NH-AIANs (APC -0.8 [95% CI, −1.2 to −0.5]). AAMR decreased in NH-APIs till 2014 followed by increase till 2019 (APC 1.7 [95% CI, 0.2 to 3.3]). AAMR decreased significantly till 2012 followed by significant increase till 2019 in NHWs (APC 2.1[95% CI, 1.5 to 2.7), NHBs (APC 1.6 [95% CI, 1.3 to 2.0), NH-APIs (APC 1.7 [95% CI, 0.2 to 3.3) and Hispanics (APC 1.2 [95% CI, 0.4 to 1.9) (Figure 1). Conclusion Heart failure related mortality in elderly has been increasing consistently since 2012. Stratification by racial/ethnic status reveals significant disparities, which calls for further research to understand the underlying factors to help develop preventative strategies. Heart failure majorly effects the elderly and accounts for significant morbidity and mortality. Important disparities in heart failure patients persist based on their racial/ethnic status. With the increase in ageing population, we aimed to study the trends in heart failure related deaths in elderly population stratified on race/ethnicity in the United States from 1999 to 2019. : We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. Heart failure related deaths in elderly (defined as age >/= 75 years) were identified using the International Classification of Diseases, Tenth Revision, codes from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC) in heart failure related deaths overall and stratified by racial/ethnic groups (non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), Hispanics, non-Hispanic Asian or Pacific Islanders (NH-APIs) and non-Hispanic American Indian or Alaska Natives (NH-AIANs). AAMR related to heart failure in elderly decreased from 1409.97 per 100,000 in 1999 to 1082.67 per 100,000 in 2012 (APC -2.1 [95% CI, −2.4 to −1.9]) and then increased to 1209.56 per 100,000 in 2019 (APC 1.7 [95% CI, 1.1 to [95% CI, −2.4 to −1.92.3]). Among the racial/ethnic groups, AAMR was highest in NHWs (1271.51) followed by NHBs (1086.59), NH-AIANs (1019.8), Hispanics (780.45) and lastly NH-APIs (570.99). AAMR continued to decrease throughout the study period from 1999-2018 in NH-AIANs (APC -0.8 [95% CI, −1.2 to −0.5]). AAMR decreased in NH-APIs till 2014 followed by increase till 2019 (APC 1.7 [95% CI, 0.2 to 3.3]). AAMR decreased significantly till 2012 followed by significant increase till 2019 in NHWs (APC 2.1[95% CI, 1.5 to 2.7), NHBs (APC 1.6 [95% CI, 1.3 to 2.0), NH-APIs (APC 1.7 [95% CI, 0.2 to 3.3) and Hispanics (APC 1.2 [95% CI, 0.4 to 1.9) (Figure 1). Heart failure related mortality in elderly has been increasing consistently since 2012. Stratification by racial/ethnic status reveals significant disparities, which calls for further research to understand the underlying factors to help develop preventative strategies.