Age-adjusted Cardiovascular Mortality Research Articles

Lack of leisure time physical activity and variations in cardiovascular mortality across US communities: a comprehensive county-level analysis (2011–2019)

ObjectivesTo investigate the associations between county-level proportions of adults not engaging in leisure-time physical activity (no LTPA) and age-adjusted cardiovascular mortality (AACVM) rates in the overall US population and across...

Mapping the Heartbeat of America with ChatGPT-4: Unpacking the Interplay of Social Vulnerability, Digital Literacy, and Cardiovascular Mortality in County Residency Choices.

Cardiovascular disease remains a leading cause of morbidity and mortality in the United States (US). Although high-quality data are accessible in the US for cardiovascular research, digital literacy (DL) has not been explored as a potential factor influencing cardiovascular mortality, although the Social Vulnerability Index (SVI) has been used previously as a variable in predictive modeling. Utilizing a large language model, ChatGPT4, we investigated the variability in CVD-specific mortality that could be explained by DL and SVI using regression modeling. We fitted two models to calculate the crude and adjusted CVD mortality rates. Mortality data using ICD-10 codes were retrieved from CDC WONDER, and the geographic level data was retrieved from the US Department of Agriculture. Both datasets were merged using the Federal Information Processing Standards code. The initial exploration involved data from 1999 through 2020 (n = 65,791; 99.98% complete for all US Counties) for crude cardiovascular mortality (CCM). Age-adjusted cardiovascular mortality (ACM) had data for 2020 (n = 3118 rows; 99% complete for all US Counties), with the inclusion of SVI and DL in the model (a composite of literacy and internet access). By leveraging on the advanced capabilities of ChatGPT4 and linear regression, we successfully highlighted the importance of incorporating the SVI and DL in predicting adjusted cardiovascular mortality. Our findings imply that just incorporating internet availability in the regression model may not be sufficient without incorporating significant variables, such as DL and SVI, to predict ACM. Further, our approach could enable future researchers to consider DL and SVI as key variables to study other health outcomes of public-health importance, which could inform future clinical practices and policies.

Trends in CV mortality among patients with known mental and behavioral disorders in the US between 1999 and 2020.

Patients with mental disorders are at increased risk of cardiovascular events. We aimed to assess the cardiovascular mortality trends over the last two decades among patients with mental and behavioral co-morbidities in the US. We performed a retrospective, observational study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death dataset. We determined national trends in age-standardized mortality rates attributed to cardiovascular diseases in patients with and without mental and behavioral disorders, from 1999 to 2020, stratified by mental and behavioral disorders subtype [ICD10 codes F], age, gender, race, and place of residence. Among more than 18.7 million cardiovascular deaths in the United States (US), 13.5% [2.53 million] were patients with a concomitant mental and behavioral disorder. During the study period, among patients with mental and behavioral disorders, the age-adjusted mortality rate increased by 113.9% Vs a 44.8% decline in patients with no mental disorder (both p<0.05). In patients with mental and behavioral disorders, the age-adjusted mortality rate increased more significantly among patients whose mental and behavioral disorder was secondary to substance abuse (+532.6%, p<0.05) than among those with organic mental disorders, such as dementia or delirium (+6.2%, P- nonsignificant). Male patients (+163.6%) and residents of more rural areas (+128-162%) experienced a more prominent increase in age-adjusted cardiovascular mortality. While there was an overall reduction in cardiovascular mortality in the US in the past two decades, we demonstrated an overall increase in cardiovascular mortality among patients with mental disorders.

Geographically Weighted Modeling to Explore Social and Environmental Factors Affecting County-Level Cardiovascular Mortality in People With Diabetes in the United States: A Cross-Sectional Analysis

Disparities exist in the cardiovascular mortality rates among people with type 2 diabetes (T2D). Research has established that these disparities are often related to the environmental and social determinations of health. This study explores the spatial variation between air pollution, social determinants of health and T2D related age-adjusted cardiovascular mortality (aa-CVM) in the United States. We obtained county-level T2D related to aa-CVM (per 100,000 residents) from Centers for Disease Control and Prevention WONDER (Wide-ranging Online Data for Epidemiologic Research) (2010 to 2019). We fit a geographically weighted linear regression with aa-CVM as the outcome and the following covariates (ambient air pollution [particulate matter of 2.5 µm size], median annual household income, racial/ethnic minorities, higher education, rurality, food insecurity, and primary health care access) were included. Overall, the median aa-CVM rate was 92.9 and highest in the South (102.2). In the West, aa-CVM was significantly associated with particulate matter of 2.5 µm size, annual median household income, racial minority status and primary health care access. Food insecurity was the most significant exposure in the Midwest and Northeast, while in the South, annual median household income and food insecurity were significant. In conclusion, this study demonstrated a substantial regional variation of exposure to determinants of T2D related aa-CVM in the United States. These findings should be considered in policy frameworks and interventions as part of community-level approaches to addressing T2D related aa-CVM, and within broader state and national discussions of the importance of population health.

Food Environment Quality and Cardiovascular Disease Mortality in the United States: a County-Level Analysis from 2017 to 2019.

Upstream socioeconomic circumstances including food insecurity and food desert are important drivers of community-level health disparities in cardiovascular mortality let alone traditional risk factors. The studyassessed the association between differences in food environment quality and cardiovascular mortality in US adults. Retrospective analysis of the association between cardiovascular mortality among US adults aged 45 and above and food environment quality, measured as the food environment index (FEI), in 2615 US counties. FEI was measured by equal weights of food insecurity (limited access to a reliable food source) and food desert (limited access to healthy food), ranging from 0 (worst) to 10 (best).Age-adjusted cardiovascular mortality rates per 100,000 adults aged 45 and above in the calendar year 2017-2019. County-level association between CVD mortality rate and FEI was modeled using generalized linear regression. Data were weighted using county population. Median CVD deaths per 100,000 population were 645.4 (IQR 561.5, 747.0) among adults aged 45years and above across US counties in 2017-2019. About 12.8% (IQR 10.7%, 15.1%) of residents were food insecure and 6.3% (IQR 3.6%, 9.9%) were living in food desert areas. Comparing counties by FEI quartiles, the CVD mortality rate was higher in the least healthy FE counties (704.3 vs 598.6 deaths per 100,000 population) compared to the healthiest FE counties. One unit increase in FEI was associated with - 12.95 CVD deaths/100,000 population. In the subgroup analysis of counties with higher income inequality, the healthiest food environment was associated with 46.4 lower CVD deaths/100,000 population than the least healthy food environment. One unit increase in FEI in counties with higher income inequality was associated with a fivefold decrease in CVD mortality difference in African American counties (- 18.4 deaths/100,000 population) when compared to non-African American counties (- 3.63 deaths/100,000 population). In this retrospective multi-county study in the USA, a higher food environment index was significantly associated with lower cardiovascular mortality.

A STUDY OF ELECTROCARDIOGRAPHIC AND ECHOCARDIOGRAPHIC CHANGES IN PATIENTS OF CHRONIC KIDNEY DISEASE

Introduction: Chronic kidney disease is dened as the presence of kidney damage or an estimated glomerular ltration rate less than 60 ml/min/1.73 mt2, persisting for 3 months or more, irrespective of the cause. It is a state of progressive loss of kidney function ultimately resulting in the need for renal replacement therapy . A cardiovascular mortality that is 15 to 30 times greater than the age-adjusted cardiovascular mortality in the general population affects roughly 50% of people with ESRD. Therefore this study was undertaken for assessing electrocardiographic and echocardiographic ndings in CKD patients. Method: In this study 50 pts of chronic kidney disease as per KDIGO criteria were enrolled over a period of six months (Jan-June 2022).All relevant data were recorded and analyzed. Results: Among 50 pts, 26 percent of the patients each belonged to the age group of 61 to 70 years. 62 percent of the CKD patients were males while the remaining were females. While assessing the ECGndings among CKD patients, LVH and arrythmias were seen in 52 percent and 44 percent of the patients. While assessing the correlation of ECGndings with CKD severity grading, it was seen that ECG variables were signicantly deteriorate with increasing severity of CKD grading. While analysing ECHO ndings among CKD patients, abnormal ndings were seen in 88 percent of the patients . While assessing the correlation of ECHO ndings with CKD severity grading, it was seen that ECHO variables were signicantly deteriorate with increasing severity of CKD grading. Conclusion : LVH, LAE were very common ECG and ECHO abnormalities in CKD patients. Cardiac disorders are highly prevalent in patients with progressive CKD. All CKD patients must be evaluated for cardiac co-morbidities, since it might help to establish adequate treatment that may potentially improve patient's prognosis.

Has the first year of the COVID-19 pandemic reversed the trends in CV mortality between 1999 and 2019 in the United States?

Although cardiovascular (CV) mortality increased during the COVID-19 pandemic, little is known about how these patterns varied across key subgroups, including age, sex, and race and ethnicity, as well as by specific cause of CV death. The Centers for Disease Control WONDER database was used to evaluate trends in age-adjusted CV mortality between 1999 and 2020 among US adults aged 18 and older. Overall, there was a 4.6% excess CV mortality in 2020 compared to 2019, which represents an absolute excess of 62802 deaths. The relative CV mortality increase between 2019 and 2020 was higher for adults under 55 years of age (11.9% relative increase), vs. adults aged 55-74 (7.9% increase), and adults 75 and older (2.2% increase). Hispanic adults experienced a 9.4% increase in CV mortality (7400 excess deaths) vs. 4.3% for non-Hispanic adults (56760 excess deaths). Black adults experienced the largest % increase in CV mortality at 10.6% (15477 excess deaths) vs. 3.5% increase (42907 excess deaths) for White adults. Among individual causes of CV mortality, there was an increase between 2019 and 2020 of 4.3% for ischaemic heart disease (32293 excess deaths), 15.9% for hypertensive disease (13800 excess deaths), 4.9% for cerebrovascular disease (11218 excess deaths), but a decline of 1.4% for heart failure mortality. The first year of the COVID pandemic in the United States was associated with a reversal in prior trends of improved CV mortality. Increases in CV mortality were most pronounced among Black and Hispanic adults.

Trend in CV mortality among patients with mental disorder in the US between 1999–2020

Abstract Background Patients with mental disorders are at increased risk of cardiovascular mortality. While the overall cardiovascular mortality rate in the western world is in decline, there is no up-to-date data on the cardiovascular mortality rates among patients with mental disorders. We aimed to assess the cardiovascular mortality trends over the last two decades among patients with mental co-morbidities in the US. Methods Using Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death data set, we determined national trends in age-standardized mortality rates attributed to cardiovascular diseases in patients with and without mental disorders, from 1999 to 2020, stratified by mental disorders subtype, age, gender, race, and place of residence. Results Among more than 18.7 million cardiovascular deaths in the United States, 13.5% were patients with a concomitant mental disorder. During the study period, among patients with mental disorders, the age-adjusted mortality rate increased by 113.9% (vs 44.8% decline in patients with no mental disorder). In patients with mental disorders, the age-adjusted mortality rate increased more significantly among patients whose mental disorder in secondary to substance abuse (+532.6%) than among with organic mental disorders, such as dementia or delirium (+6.2%), while among patients with mood disorders the age-adjusted CV mortality rate dropped by 23.5%. Men patients, minorities, and residents of more rural areas experienced a more prominent increase in the age-adjusted cardiovascular mortality compared to women, white, and residents of metro areas. Conclusions While there was an overall reduction in cardiovascular mortality in the US in the past two decades, we demonstrated an overall increase in cardiovascular mortality among patients with mental disorders. The increase was more significant among patients with substance abuse-related mental disorders, in men, minorities, and residents of rural areas. Funding Acknowledgement Type of funding sources: None.

Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019.

Black adults experience a disproportionately higher burden of cardiovascular risk factors and disease in comparison with White adults in the United States. Less is known about how sex-based disparities in cardiovascular mortality between these groups have changed on a national scale over the past 20 years, particularly across geographic determinants of health and residential racial segregation. We used CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) to identify Black and White adults age ≥25 years in the United States from 1999 to 2019. We calculated annual age-adjusted cardiovascular mortality rates (per 100 000) for Black and White women and men, as well as absolute rate differences and rate ratios to compare the mortality gap between these groups. We also examined patterns by US census region, rural versus urban residence, and degree of neighborhood segregation. From 1999 to 2019, age-adjusted mortality rates declined overall for both Black and White adults. There was a decline in age-adjusted cardiovascular mortality among Black (602.1 to 351.8 per 100 000 population) and White women (447.0 to 267.5), and the absolute rate difference (ARD) between these groups decreased over time (1999: ARD, 155.1 [95% CI, 149.9-160.3]; 2019: ARD, 84.3 [95% CI, 81.2-87.4]). These patterns were similar for Black (824.1 to 526.3 per 100 000) and White men (637.5 to 396.0; 1999: ARD, 186.6 [95% CI, 178.6-194.6]; 2019: ARD, 130.3 [95% CI, 125.6-135.0]). Despite this progress, cardiovascular mortality in 2019 was higher for Black women (rate ratio, 1.32 [95% CI, 1.30-1.33])- especially in the younger (age <65 years) subgroup (rate ratio, 2.28 [95% CI, 2.23-2.32])-as well as for Black men (rate ratio, 1.33 [95% CI, 1.32-1.34]), compared with their respective White counterparts. There was regional variation in cardiovascular mortality patterns, and the Black-White gap differed across rural and urban areas. Cardiovascular mortality rates among Black women and men were consistently higher in communities with high levels of racial segregation compared with those with low to moderate levels. During the past 2 decades, age-adjusted cardiovascular mortality declined significantly for Black and White adults in the United States, as did the absolute difference in death rates between these groups. Despite this progress, Black women and men continue to experience higher cardiovascular mortality rates than their White counterparts.

Trends in cardiovascular mortality of cancer patients in the US over two decades 1999–2019

Abstract Background Cancer is the second most common cause of death globally after cardiovascular (CV) disease. The present study sought to compare the trends in CV mortality between patients with and without cancer in the US over two decades (1999 to 2019), stratified by sociodemographic factors such as age, sex and geographical location. Methods In this retrospective study, the number of deaths, crude- and age-adjusted mortality rates between January 1, 1999, and December 31, 2019, were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) data set Results We examined a total of 53,422,612 deaths between 1999 and 2019; of which 33.4% were defined as CV mortality and 25.6% had malignancy. During this period, among patients with cancer, the age-adjusted mortality rate dropped by 52%. (Vs, 38% in patients with no malignancy). CV mortality was highest in patients with gastrointestinal and prostate malignancy where CV mortality accounts together for over 40% of all CV mortality in patients with cancer in 1999 and 33.6% in 2019. The age-adjusted CV mortality rate (per 100,000 people) of patients with GI and prostate cancer nearly halved over twenty years from 2.7 to 1.0 and 2.5 to 1.0. The CV age-adjusted mortality rate dropped more significantly among patients with gastrointestinal, breast, and prostate malignancy than among patients with hematological malignancy (59–63% vs. 41%. We observed that crude CV mortality rates amongst patients with cancer declined over the study period in all age groups but was more prominent among patients over 65 years old than those aged 55–64 and under 55 (51%-55% Vs. 41%, 25%, respectively).Similar reductions in mortality in men and women (54% and 53% reduction) were observed During the study period the decline in cardiovascular mortality was more prominent in metro areas which led to lower age adjusted CV mortality in Metro compared to non-Metro areas (5.7–6.3 vs 7.2). The decline in age adjusted CV mortality in patients with cancer differed significantly in different states Conclusions In our temporal analysis we show a 50% decline in CV mortality in the US over two decades in both male and female patients with cancer, that has exceeded the reduction in CV mortality seen in the non-cancer population. The greatest reductions in CV mortality were observed in patients with GI, breast and prostate malignancies, those residing in metro areas and in patients aged 65 and over. Funding Acknowledgement Type of funding sources: None. CV death among cancer patients

Geographic Variation in Cardiovascular Health Among American Adults

ObjectiveTo evaluate the contemporary geographic trends in cardiovascular health in the United States and its relationship with geographic distribution of cardiovascular mortality. MethodsBy use of a retrospective cross-sectional design, the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) was queried to determine the age-adjusted prevalence of cardiovascular health index (CVHI) metrics (sum of ideal blood pressure, blood glucose concentration, lipid levels, body mass index, smoking, physical activity, and diet). Cardiovascular health was estimated as both continuous (0 to 7 points) and categorical (ideal, intermediate, poor) variables from the BRFSS. Age-adjusted cardiovascular mortality for 2017 was obtained from the Centers for Disease Control and Prevention WONDER database. ResultsAmong 1,362,529 American adult participants of the BRFSS 2011-2017 and all American residents in 2017, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.005 in 2017 (Ptrend<.001) nationally, with modest improvement across all regions (Ptrend<.05 for all). Ideal cardiovascular health prevalence improved in the northeastern (Ptrend=.03) and southern regions (Ptrend=.002). In 2017, the prevalence of coronary heart disease (6.8%; 95% CI, 6.5% to 7.1%) and stroke (3.7%; 95% CI, 3.4% to 3.9%) was highest in the southern region. The CVHI score (3.81±0.01) and the prevalence of ideal cardiovascular health (12.2%; 95% CI, 11.7% to 12.7%) were lowest in the southern United States. This corresponded to the higher cardiovascular mortality in the southern region (233.0 [95% CI, 232.2- to 33.8] per 100,000 persons). ConclusionDespite a modest improvement in CVHI, only 1 in 6 Americans has ideal cardiovascular health with significant geographic differences. These differences correlate with the geographic distribution of cardiovascular mortality. An urgent unmet need exists to mitigate the geographic disparities in cardiovascular morbidity and mortality.

Association Between County-Level Change in Economic Prosperity and Change in Cardiovascular Mortality Among Middle-aged US Adults

After a decline in cardiovascular mortality for nonelderly US adults, recent stagnation has occurred alongside rising income inequality. Whether this is associated with underlying economic trends is unclear. To assess the association between changes in economic prosperity and trends in cardiovascular mortality in middle-aged US adults. Retrospective analysis of the association between change in 7 markers of economic prosperity in 3123 US counties and county-level cardiovascular mortality among 40- to 64-year-old adults (102 660 852 individuals in 2010). Mean rank for change in 7 markers of economic prosperity between 2 time periods (baseline: 2007-2011 and follow-up: 2012-2016). A higher mean rank indicates a greater relative increase or lower relative decrease in prosperity (range, 5 to 92; mean [SD], 50 [14]). Mean annual percentage change (APC) in age-adjusted cardiovascular mortality rates. Generalized linear mixed-effects models were used to estimate the additional APC associated with a change in prosperity. Among 102 660 852 residents aged 40 to 64 years living in these counties in 2010 (51% women), 979 228 cardiovascular deaths occurred between 2010 and 2017. Age-adjusted cardiovascular mortality rates did not change significantly between 2010 and 2017 in counties in the lowest tertile for change in economic prosperity (mean [SD], 114.1 [47.9] to 116.1 [52.7] deaths per 100 000 individuals; APC, 0.2% [95% CI, -0.3% to 0.7%]). Mortality decreased significantly in the intermediate tertile (mean [SD], 104.7 [38.8] to 101.9 [41.5] deaths per 100 000 individuals; APC, -0.4% [95% CI, -0.8% to -0.1%]) and highest tertile for change in prosperity (100.0 [37.9] to 95.1 [39.1] deaths per 100 000 individuals; APC, -0.5% [95% CI, -0.9% to -0.1%]). After accounting for baseline prosperity and demographic and health care-related variables, a 10-point higher mean rank for change in economic prosperity was associated with 0.4% (95% CI, 0.2% to 0.6%) additional decrease in mortality per year. In this retrospective study of US county-level mortality data from 2010 to 2017, a relative increase in county-level economic prosperity was significantly associated with a small relative decrease in cardiovascular mortality among middle-aged adults. Individual-level inferences are limited by the ecological nature of the study.

Socioeconomic position and cardiovascular mortality in 63 million adults from Brazil

BackgroundIt has been suggested that cardiovascular disease exhibits a ‘social cross-over’, from greater risk in higher socioeconomic groups to lower socioeconomic groups, on economic development, but robust evidence is lacking....

Characteristics and in-hospital outcomes of patients on chronic hemodialysis with ischemic heart disease undergoing percutaneous coronary intervention

Among patients with advanced chronic kidney disease (CKD), cardiovascular disease (CVD) is the leading cause of death, 15 to 30 times higher than the age-adjusted cardiovascular mortality rate il the general population. We sought to determine demographic features, cardiovascular risk factors, clinical presentation, in-hospital course and prognosis of patients on chronic hemodialysis undergoing percutaneous coronary intervention (PCI). The study was carried out on a retrospective registry including 6544 patients undergoing PCI in the Cardiology Department of Fattouma bourguiba University Hospital (Monastir, Tunisia) between January 2014 and March 2018. Out of the overall population, 214 patients were part of the CKD group and 71 were on chronic dialysis (1.1%) via arteriovenous fistula in 94.4% of cases. Forty-nine (69%) of them were male. Mean age was 58.9 ± 10.9 years (33–80 years). Dialysis patients had higher prevalence of high blood pressure (81.7%) and diabetes mellitus (49.3%). Only the third of patients was hospitalized in intensive care unit and median period of hospitalization was 10 days. At admission, CKD patients presented most commonly with non ST-elevation myocardial infarction, stable angina and ST-elevation myocardial infarction respectively in 49%, 29.5% and 14%. In-hospital complications were a blend of cardiogenic shock (2 cases), new onset atrial fibrillation (5 cases), atrioventricular block (2 cases), ventricular fibrillation (1 case), heart failure (12 cases) and ischemic mitral insufficiency (5 cases). Left ventricular function was preserved among 45% of patients and left ventricular hypertrophy was noted in 55%. Patients with CKD on chronic dialysis carry a considerable burden of CVD relative to patients with normal renal function. Initial clinical presentation was very impactful on in-hospital outcomes.

County-level phenomapping to identify disparities in cardiovascular outcomes: An unsupervised clustering analysis: Short title: Unsupervised clustering of counties and risk of cardiovascular mortality

IntroductionSignificant heterogeneity in cardiovascular disease (CVD) risk and healthcare resource allocation has been demonstrated in the United States, but optimal methods to capture heterogeneity in county-level characteristics that contribute to CVD mortality differences are unclear. We evaluated the feasibility of unsupervised machine learning (ML)-based phenomapping in identifying subgroups of county-level social and demographic risk factors with differential CVD outcomes. MethodsWe performed a cross-sectional study using county-level data from 2008 to 2018 from the Centers for Disease Control (CDC) WONDER platform and the 2020 Robert Wood Johnson County Health Rankings program. Unsupervised clustering was performed on 46 facets of population characteristics spanning the demographic, health behaviors, socioeconomic, and healthcare access domains. Spatial autocorrelation was assessed using the Moran’s I test, and temporal trends in age-adjusted CVD outcomes were evaluated using linear mixed effect models and least square means. ResultsAmong 2676 counties, 4 county-level phenogroups were identified (Moran’s I p-value <0.001). Phenogroup 1 (N ​= ​924; 24.5%) counties were largely white, suburban households with high income and access to healthcare. Phenogroup 2 counties (N ​= ​451; 16.9%) included predominantly Hispanic residents and below-average prevalence of CVD risk factors. Phenogroup 3 (N ​= ​951; 35.5%) counties included rural, white residents with the lowest levels of access to healthcare. Phenogroup 4 (350; 13.1%) comprised counties with predominantly Black residents, substantial cardiovascular comorbidities, and physical and socioeconomic burdens. Least square means in age-adjusted cardiovascular mortality over time increased in a stepwise fashion from 223 in phenogroup 1 to 317 per 100,000 residents in phenogroup 4. ConclusionsUnsupervised ML-based clustering on county-level population characteristics can identify unique phenogroups with differential risk of CVD mortality. Phenogroup identification may aid in developing a uniform set of preventive initiatives for clustered counties to address regional differences in CVD mortality.

Abstract 15076: County-level Subgroups With Unique Cardiovascular Outcomes: An Unsupervised Clustering Analysis

Introduction: Regional heterogeneity in cardiovascular disease (CVD) risk has been demonstrated in the United States (US), however associations between county-level social and demographic risk factors and CVD mortality have not previously been described. To address this, we evaluated whether unsupervised machine learning-based clustering could identify distinct US county subgroups with unique CVD outcomes. Methods: The study included 2,676 counties from the 2020 County Health Rankings program. Unsupervised hierarchical clustering of 46 candidate variables encompassing demographic, health behaviors, socioeconomic factors, and healthcare access domains was used to derive phenogroups. The association of phenogroups and age-adjusted CVD mortality was assessed by linear regression. Results: Clustering identified 4 phenogroups based on within-cluster inertia. Cluster 1 (N=924; 24.5%) counties were largely white, suburban households with high income and access to healthcare. Cluster 2 counties (N=451; 16.9%) were large with predominantly Hispanic residents and below average prevalence of CVD risk factors. Cluster 3 (N=951; 35.5%) counties included rural, white residents with the lowest levels of healthcare access. Cluster 4 (350; 13.1%) counties were comprised of predominantly black residents with substantial cardiovascular comorbidities and physical and socioeconomic burdens. Age-adjusted cardiovascular mortality increased in a stepwise fashion from 247 in cluster 1 to 349 per 100,000 residents in cluster 4 (FigA) with the phenogroups demonstrating regionality across the US (FigB). Addition of phenogroup in linear regression improved model performance with a R 2 of 0.70. Conclusions: Unsupervised machine learning clustering based on demographic and behavior data can identify unique county phenogroups with differential risk of CVD mortality and may aid in identifying communities at highest risk for CVD-related adverse events.

Abstract 13360: The Association Between Food Insecurity and Cardiovascular Mortality in the United States From 2011 to 2017 - A Longitudinal Analysis

Introduction: Prior analyses suggest a link between food insecurity and cardiovascular (CV) health but are limited by cross-sectional designs. We investigated whether longitudinal changes in food insecurity are independently associated with CV mortality. Methods: Using National Center for Health Statistics data, we determined annual U.S. county-level age-adjusted CV mortality rates for non-elderly (20-64 years old) and elderly (65 years and older) adults. County-level food insecurity rates were obtained from the Map the Meal Gap project. We examined CV mortality trends by quartiles of average annual percent change (APC) in food insecurity. Using a Poisson fixed effects estimator, we assessed the association between longitudinal changes in food insecurity and CV mortality rates after accounting for time-varying demographic (proportion of residents who were male, black, Hispanic), economic (median household income, unemployment, poverty, education attainment, and housing vacancy rates), and healthcare access (insurance coverage, density of healthcare providers and hospital beds) variables. Results: Between 2011 and 2017, mean food insecurity rates decreased from 14.7% to 13.3%. In counties in the highest quartile of APC for absolute value change in food insecurity, non-elderly CV mortality increased from 82.2(SD=33.9) to 87.4(SD=37.3) per 100,000 individuals (p&lt;0.001), while in counties in the lowest quartile of APC, mortality was stable [60.8(SD=22.2) to 60.0(SD=23.0) per 100,000 individuals, p=0.64]. Elderly CV mortality significantly declined in all quartiles [1643.3(SD=315.7) to 1542.7(SD=299.4) per 100,000 (p&lt;0.001) in the highest quartile and 1408.3(SD=225.9) to 1338.6(SD=213.8) per 100,000 (p&lt;0.001) in the lowest quartile). A 1 percentage point increase in food insecurity was independently associated with a 0.83% (95% CI 0.42 - 1.25, P&lt;0.001) increase in CV mortality for non-elderly adults. This was not significant for elderly adults (-0.06%, 95% CI -0.39 - 0.28, P=0.74). Conclusion: From 2011 to 2017, an increase in food insecurity was independently associated with an increase in CV mortality rates for non-elderly adults in the U.S. Interventions targeting food insecurity may play a role in improving community CV health.

Abstract 17284: Geographic Variation in Cardiovascular Health Among American Adults

Background: There are longstanding and pervasive geographic disparities in cardiovascular (CV) health in the US. We sought to evaluate the contemporary trends in CV risk factors by census regions from 2011-2017. The region-specific CV mortality for 2017 was evaluated to assess the geographic overlap between risk factors, CV mortality, and COVID-19 mortality. Methods: The age-adjusted prevalence (per 2010 US census proportions) of CV health index (CVHI) metrics (sum of ideal blood pressure, blood glucose, lipid levels, body mass index, smoking status, physical activity, and diet) (0-7 points), were estimated as both continuous and categorical (ideal, intermediate and poor CVHI) measures in the 2011-2017 BRFSS. Regional trends were evaluated with multivariable-adjusted logistic regression models. Age-adjusted CV mortality for 2017 was derived from the CDC WONDER database. COVID-19 crude mortality rates were ascertained from respective state public health departments. Results: Among 1,362,529 American adults, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.01 in 2017 (P&lt;0.001), modestly improvements in all regions (P&lt;0.05 for all). Ideal CV health prevalence improved only in the northeastern (P=0.03) and southern regions (P=0.002). The CVHI score (3.81±0.01) and prevalence of ideal CV health [2017: 12.2% (95% CI: 11.7-12.7%)] was lowest in southern US. This corresponded with the distribution of CV mortality (per 100,000 persons), which was highest in southern region (233.0 [95% CI: 232.2-233.8]) and lowest in western region (197.5 [95% CI: 19.6-198.5]) ( Figure 1 ). State-level distribution of poor CV health did not track with COVID-19 mortality. Conclusion: Despite a modest improvement in CVHI, only one-in-six Americans have ideal CV health with significant regional and state-level differences that correlate with the geographical distribution of CV mortality but not COVID-19 mortality. These disparities may worsen after the COVID-19 pandemic.

Determinants of Exercise, Fulfilling the Recommendations for Aerobic Physical Activity and Health Status: Results of a Correlation Study in the Federal States of Austria

Zusammenfassung Ziel der Studie Ziel dieser Analyse war es, Zusammenhänge zu untersuchen zwischen Personen, die die ausdauerorientierten Bewegungsempfehlungen erfüllen und dem Wissen um die Bewegungsempfehlungen, die wahrgenommene bewegungsförderliche Kultur und Umgebung sowie den Gesundheitszustand getrennt nach Bundesländern. Methodik Für die Analyse wurden Daten aus dem österreichischen Bewegungsmonitoring 2017, der österreichischen Gesundheitsbefragung 2014, der Mortalitätsstatistik 2015, der Fit-Sport-Austria Datenbank, der Wirtschaftskammer, dem Verkehrsministerium und einer Online-Lauf-Plattform herangezogen. Korrelationskoeffizienten (Pearson) verschiedener Parameter mit den Bevölkerungsanteilen, die die ausdauerorientierten Bewegungsempfehlungen erfüllten, wurden errechnet. Ergebnisse Ausdauerorientierte Bewegung korrelierte signifikant mit dem Wissen zum empfohlenen Bewegungsumfang (0,91), Angeboten in (0,87) und subjektiver Erreichbarkeit von Sportvereinen (0,85), Erreichbarkeit von Grünräumen (0,84), Anzahl an Sportvereinen mit zertifizierten gesundheitsförderlichen Angeboten (0,76), und den Möglichkeiten Laufen zu gehen (0,72). Außerdem korrelierte ausdauerorientierte Bewegung negativ mit der altersstandardisierten kardiovaskulären Mortalität (−0,96), der Gesamtmortalität (−0,95), der Prävalenz von Adipositas (−0,83), der Mortalität an ischämischen Herzerkrankungen (−0,76), der Prävalenz chronischer Krankheiten (−0,68), sowie positiv mit der subjektiv wahrgenommenen Gesundheit (0,79). Schlussfolgerung Zum einen zeigten sich positive signifikante Zusammenhänge zwischen Wissen um die Bewegungsempfehlungen, der Infrastruktur und der bewegungsförderlichen Kultur mit dem Bewegungsverhalten. Zum anderen korrelierte das Bewegungsverhalten mit dem Gesundheitszustand in den jeweiligen Bundesländern. Zusätzlich lassen sich spezifische Empfehlungen, zugeschnitten auf die einzelnen Bundesländer, ableiten.

P3415Will less developed countries be capable of giving high-quality universal coverage to cardiovascular disease survivors? Results from a national health survey, Chile ENS 2016–2017

Abstract Background Chilean Health System has fully implemented Universal Health Coverage (UHC) for acute cardiovascular events since 2005. Age-adjusted cardiovascular mortality has decreased, but there is limited information about coverage and quality of chronic health care given to cardiovascular disease (CVD) survivors at the national level. Purpose To assess the prevalence and quality of care in Chilean adult CVD survivors. Methods Chilean National Health Survey 2016–2017 (ENS 2016–2017) is a random stratified multistage sample of non-institutionalized population over 14 years (n=6240). Age, education, gender, rural/urban and geographical area weighted prevalence of CVD survivors (self-reported medical diagnosis of myocardial infarction or cerebrovascular attack) were calculated. High quality of care was defined as meeting six criteria simultaneously: under 70mg% LDL- C level, statin use, aspirin use, blood pressure under 130/80 mmHg, HgA1C&lt;7 or 8 (&gt;74-year-old) and non-smoking. Quality of care was explored using multivariate linear and logistic regression adjusting by age, gender, education and year of diagnosis (before or after UHC). Results Weighted national prevalence of CVD survivors in over 20-year-old population was 6.1%. The sample size for the CVD survivor analyses was n=455. 28.7% of CVS had their first event before the year 2005 (n=141). Overall 27.9% had LDL-C under 70mg%, 37.8% used statins, 41.4% used aspirin, 37.8% had controlled blood pressure, 78.3% were non-smokers and 84.3% had good glycemic control. National “high quality of care” prevalence in CVD survivors was 0.3%, 0.4% and 0.1% for men and women respectively. LDL and Blood pressure control prevalence (meet both criteria simultaneously) was 4,4%. In the adjusted multivariate model age was associated to a higher number of quality criteria achievement. Conclusion The number of CVD survivors in Chile is a huge challenge for the health care system. Universal coverage does not guarantee the quality of chronic life long care. Specific surveillance in high-risk population is needed to assess the system's effectiveness and accountability. Acknowledgement/Funding ENS 2016-2017 was funded by the chilean Ministry of Health (MINSAL)