Higher Age-adjusted Mortality Research Articles

Abstract WP201: Increasing Mortality From Ischemic Stroke In The US, Racial And Etiological Analysis

Background: Ischemic stroke is the fifth leading cause of death in the United States. In spite of the recent advances in the management of ischemic stroke, mortality rates remain high and have increased in recent years. Importantly, mortality differs by race, with African Americans more likely to die from stroke. To better understand stroke mortality we examined data from 1999 through 2018 with respect to both race and stroke subtype. Methods: Using the Multiple Cause Of Death Database, we identified all patients who died of cerebral infarction (CI) using the International Classification of Diseases, 10th revision code I63. Age-adjusted mortality rates (AAMR) standardized to the 2000 US census data were used. Data for continuous variables were examined using simple linear regression models and multivariable linear regression models controlling for relevant covariates. All tests were two-tailed and p < 0.05 was considered significant. Results: A total of 201,157 CI deaths were identified between 1999 and 2018. AAMR showed a U-shaped trend, such that compared to 1999-2004 (4.52±0.60) AAMR decreased from 2005-2014 (2.06±0.20), p < 0.001, and increased from 2015-2018 (3.63±1.32), p < 0.001. AAMR differed significantly by race, p = 0.045. Rates were 3.05+1.26 for Caucasians and 4.04+1.74 for African Americans. AAMR decreased between 1999 and 2018 for thrombotic strokes, p < 0.001, while AAMR increased over this time for embolic stroke, p < 0.001. Amongst Caucasians, there was no significant differences in AAMR for each stroke subtype from 1999 to 2018, p = 0.081. However, for African Americans, there was a significantly higher AAMR for thrombotic strokes (0.56±0.33) compared to embolic strokes (0.33±0.15), p = 0.006. Conclusion: Despite recent advances in ischemic stroke management, AAMR has increased in the last 4 years by 1.8 times. AAMR in African Americans is 1.3 times that of Caucasians with African American mortality from thrombotic stroke being 1.7 times higher than from embolic stroke. Mortality from CI caused by embolism increased by 2.8 times over the study period while that due to thrombosis decreased by 5 times. Further studies are needed to clarify the reasons behind the recent increase in AAMR.

High mortality and high PCDD/Fs exposure among residents downwind of municipal solid waste incinerators: A case study in China

Studies on the human body burden of dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in populations around municipal solid waste incinerators (MSWIs) in China are limited. The objective of this study was to assess the potential adverse health effects of an 8-year MSWI on the surrounding population and identify possible exposure pathways. We hypothesized that the MSWI would result in different environmental impacts and population health outcomes between upwind and downwind of its 3 km vicinity. We conducted a 10-year retrospective mortality survey on the population surrounding the MSWI. Then, we selected 50 residents aged 50 years or older on each of the upwind and downwind sides of MSWI to test serum PCDD/Fs. Meanwhile, environmental and food exposures to PCDD/Fs were tested for selected residents. The age-adjusted mortality rates were significantly higher for residents downwind than upwind, but no significant difference was found in the standardized mortality ratio before and after the MSWI operation. The toxic equivalents (TEQ) and major congeners of PCDD/Fs were significantly higher in the sera of the downwind residents than in the upwind. The PCDD/Fs in air, soil, dust, and vegetables on the downwind side were not significantly different from those on the upwind side, but the mean concentrations of PCDD/Fs in downwind hen eggs was significantly higher than those from upwind. In conclusion, downwind residents living within 3 km of the MSWI had higher age-adjusted mortality and serum level of PCDD/Fs than upwind residents. This higher mortality rate among downwind residents was not associated with MSWI. However, the higher levels of PCDD/Fs in downwind hen eggs suggest that the downwind population dioxin exposure was related to their location.

Abstract 14356: Trends of Acute Myocardial Infarction Mortality Rates in the United States From 1999-2019: A Retrospective Study

Introduction: In the current study, we examined the temporal trends in mortality across gender, race, and 10-year age groups over last two-decades. Methods: We conducted a retrospective population-based study using Centers for Disease Control and Prevention database. Subjects with underlying cause of death from AMI were identified using validated ICD10 codes. Age adjusted mortality rates were calculated for gender and race whereas crude rates were calculated for 10-year age group. Using Poisson regression, we estimated the rate ratio between race/ethnicity pairs adjusting for age and sex in order to analyze temporal trend. Results: We identified 2,709,173 subjects with reported underlying cause of death as AMI between January-2000 to December-2019 of which 54.7% were males (n=1,483,163). The age adjusted mortality rate per 100,000 was higher in males compared to females (52.4% vs 30.7%, OR: 1.66 [1.45-1.89]). Among ethnicities African American (AA) population had the highest age adjusted mortality rate per 100,000 [Table 1]. As expected, age group >85 years had the highest mortality rate per 100,000 constituting 30% of total deaths (78% of total deaths were noted in >65yr age group). AMI age adjusted mortality rates/100,000 showed significant decline across gender and race with highest decline in female population (66.5% decline). Highest percentage decline in mortality was noted in AA female population (68.2%) whereas in males it was the white population (62%). In females, highest percentage decline in mortality was noted in 75-84 age-group (70%) while it was >85 age-group (67%) in males. Conclusion: Over last two decades there has been a significant decline in AMI mortality rates across gender and race. AA continue to have higher age adjusted mortality rate among both male and female population (38% and 22% respectively). Further studies are needed to identify and provide targeted prevention and intervention strategies in high-risk populations.

Abstract 12079: Demographic and State-Level Trends in Mortality Due to Ischemic Heart Disease in the United States From 1999 to 2019

Introduction: Mortality from ischemic heart disease (IHD) in the United States (U.S.) has decreased recently, yet variation in IHD-related mortality trends for different demographic across U.S. states is not well described. Hypothesis: IHD mortality differs based on geography, gender, ethnicity, and race. Methods: We performed analysis using CDC WONDER database to evaluate IHD mortality trends in the U.S. between 1999 and 2019. Age-adjusted mortality rates (AAMR) per 100,000 people were evaluated and stratified by sex, race, and state. Joinpoint regression was used to assess annual rates of change in IHD-related mortality. Results: From 1999 to 2019, AAMR due to IHD decreased from 194.6/100,000 to 88.0/100,000 nationally. Black men had the highest AAMR, and Hispanic white women had the lowest AAMR throughout this period. AAMR for white men decreased nationally by 51.4% from 251.2 to 122.1; 59.1% for white women from 150.5 to 61.5; 51.8% for black men from 278.7 to 134.2; 59.9% for black women from 188 to 75.4; 54.3% for Hispanic men from 200.1 to 91.4; and 63.1% for Hispanic women from 133.1 to 49.0 (Figure). Relative decreases in AAMR across states ranged from 27.0%-70.9% for white men, 30.9%-68.9% for white women, 7.3%-80.9% for black men, 27.2%-74.7% for black women, 30.5%-79.8% for Hispanic men, and 35.8%-76.8% for Hispanic women. Based on the regression model, the annual average percent decline in IHD-related AAMR for all groups has decreased since 2011 (Figure). Conclusions: AAMR due to IHD in the U.S. has decreased from 1999 to 2019 for all demographic groups, though the rate of decline has lessened since 2011. There is significant geographic variation in reductions of IHD-related AAMR across U.S. states. These findings indicate that race, ethnicity, and geography are strongly associated with trends in mortality due to IHD. Given the ongoing disparities in mortality, further investigation into geographic differences in prevention and treatment of IHD is needed.

New insights into the burden of COVID-19 mortality for U.S. Hispanics and Blacks when examined by country/region of origin: An observational study

Florida's diverse population composition includes persons from throughout Latin America and the Caribbean. This facilitated an insightful examination of disparities in 2020 Florida COVID-19 deaths not only among racial/ethnic populations in the aggregate (non-Hispanic White, non-Hispanic Black, Hispanic) but also at the level of country/region of origin. Age-adjusted mortality rates (AAMRs) for 2020 Florida COVID-19 deaths were calculated by race, ethnicity, and country/region of origin along with mean age at death, mean number of comorbidities, and percentage of decedents who had not completed secondary education. Regression-derived mortality rate ratios (MRRs) compared death rates for each racial/ethnic/country-of-origin population to non-Hispanic whites. The overall AAMR (per 100,000) for 18,342 Florida COVID-19 deaths in 2020 was 55.4, with a much lower AAMR for non-Hispanic Whites (39.3) than for Hispanics (86.8) or Blacks (107.6). Marked differences in AAMRs were observed for specific Black and Hispanic ethnic groups from varied countries/regions of origin. COVID-19 decedents from Mexico and Central America had the highest AAMRs (170.7 and 168.8 per 100,000, respectively), lowest age at death, lowest educational level, and fewest comorbidities. Mean comorbidities were highest for Blacks (all origins) and Cuban Hispanics. Florida Blacks and Hispanics experienced disproportionately high COVID-19 mortality rates throughout 2020, with notable variability based on country/region of origin. Inequities were particularly pronounced for Hispanic populations from Mexico and Central America. To better understand these heterogeneous COVID-19 mortality trends, more nuanced racial/ethnic analyses and detailed data on social determinants of health are needed. Supplemental funding was provided by the Sylvester Comprehensive Cancer Center at University of Miami Miller School of Medicine.Research reported in this publication was also supported by the National Cancer Institute of the National Institutes of Health under Award Number P30CA240139.

Trends in Incidence and Mortality Rates of Uterine Cancer in Kentucky.

The objective of this analysis was to gauge how the incidence and mortality of uterine cancer in Kentucky have changed from 1995 through 2017. An assessment of the trends in incidence and mortality across different geographic areas and between different races was also performed. Age-adjusted annual incidence and mortality rates for uterine cancer were obtained from the Kentucky Cancer Registry. A meta-regression framework was used to assess changes in incidence and mortality rates during the time frame and to determine differences in these rates between rural versus urban counties, Appalachian versus non-Appalachian counties, and Black versus White women. The incidence of uterine cancer has significantly increased throughout the state of Kentucky since 1995. Uterine cancer incidence was 10% and 22% higher in rural and Appalachian counties, respectively, compared with urban and non-Appalachian counties (P < 0.0001) from 1995 through 2017. In contrast, urban and non-Appalachian women had higher or equivalent age-adjusted mortality from uterine cancer, compared with rural and Appalachian women, respectively. The incidence of uterine cancer was significantly higher in White women compared with Black women from 1995 through 2006, but since 2007, there has been no significant difference in uterine cancer incidence based on race. Black women had higher age-adjusted mortality than White women throughout the entire time period examined. The incidence of uterine cancer is higher in rural and Appalachian Kentucky, without a corresponding geographic trend in mortality. Uterine cancer mortality is significantly higher in Black women.

New Insights Into the Burden of COVID-19 Mortality for U.S. Hispanics and Blacks — When Examined by Country/Region of Origin

Background: Florida’s diverse population composition includes persons from throughout Latin America and the Caribbean. This facilitated an insightful examination of disparities in 2020 Florida COVID-19 deaths not only among racial/ethnic populations in the aggregate (non-Hispanic White, non-Hispanic Black, Hispanic) but also at the level of country/region of origin.Methods: Age-adjusted mortality rates (AAMRs) for 2020 Florida COVID-19 deaths were calculated by race, ethnicity, and country/region of origin along with mean age at death, mean number of comorbidities, and percentage of decedents who had not completed secondary education. Regression-derived mortality rate ratios (MRRs) compared death rates for each racial/ethnic/country-of-origin population to non-Hispanic whites.Findings: The overall AAMR (per 100,000) for 18,342 Florida COVID-19 deaths in 2020 was 55.4, with a much lower AAMR for non-Hispanic Whites (39.3) than for Hispanics (86.8) or Blacks (107.6). Marked differences in AAMRs were observed for specific Black and Hispanic ethnic groups from varied countries/regions of origin. COVID-19 decedents from Mexico and Central America had the highest AAMRs (170.7 and 168.8 per 100,000, respectively), lowest age at death, lowest educational level, and fewest comorbidities. Mean comorbidities were highest for Blacks (all origins) and Cuban Hispanics.Interpretation: Florida Blacks and Hispanics experienced disproportionately high COVID-19 mortality rates throughout 2020, with notable variability based on country/region of origin. Inequities were particularly pronounced for Hispanic populations from Mexico and Central America. To better understand these heterogeneous COVID-19 mortality trends, more nuanced racial-ethnic analyses and detailed data on social determinants of health are needed.Funding Information: Supplemental funding was provided by the Sylvester Comprehensive Cancer Center at University of Miami Miller School of Medicine. Research reported in this publication was also supported by the National Cancer Institute of the National Institutes of Health under Award Number P30CA240139. Declaration of Interests: The authors declare no potential conflicts of interests.

State-Level Health Disparity Is Associated with Sarcoidosis Mortality

Background: Sarcoidosis is associated with significant morbidity and rising health care utilization, which contribute to the health care burden and disease outcome. In the United States (US), evaluation of sarcoidosis mortality by individual states has not been investigated. Methods: We examined sarcoidosis mortality data for 1999–2018 from the Centers for Disease Control and Prevention (CDC). America’s Health Rankings (AHR) assesses the nation’s health on a state-by-state basis to determine state health rankings. The numbers of certified Sarcoidosis Clinics within the US were obtained from World Association for Sarcoidosis and Other Granulomatous Disorders (WASOG) and Foundation for Sarcoidosis Research (FSR). The associations between sarcoidosis mortality and state health disparities were calculated by linear regression analyses. Results: From 1999 to 2018, the mean age-adjusted mortality rate (AAMR) in all populations, African Americans and European Americans were 2.9, 14.8, and 1.4 per 1,000,000 population, respectively. South Carolina had the highest AAMR for all populations (6.6/1,000,000) and African Americans (20.8/1,000,000). Both Utah and Vermont had the highest AAMR for European Americans (2.6/1,000,000). New York State and South Atlantic had the largest numbers of FSR-WASOG Sarcoidosis Clinics (6 and 13, respectively). States with better health rankings were significantly associated with lower AAMR in all population (R2 = 0.170, p = 0.003) but with higher AAMR in European Americans (R2 = 0.223, p < 0.001). Conclusions: There are significant variations in sarcoidosis mortality within the US. Sarcoidosis mortality was strongly associated with state health disparities. The current study suggests sarcoidosis mortality could be an indicator to reflect the state-level health care disparities in the US.

Epithelial ovarian cancer survival by race/ethnicity in an equal-access healthcare population.

e18525 Background: Previous studies in the general population have observed that compared with Non-Hispanic White (NHW) women, Pacific Islander (PI) and Non-Hispanic Black (NHB) women have higher age-adjusted mortality rates from epithelial ovarian cancer (EOC), while Asian Americans (AS) have lower mortality. It is unknown whether these patterns reflect biological differences, environmental exposure or perhaps access to care. Our objective was to investigate whether self-reported race/ethnicity is associated with differences in EOC survival in a Military population where patients have equal access to healthcare. Methods: The study population included women diagnosed with EOC (ovarian, fallopian tube and primary peritoneal cancers) among US Department of Defense beneficiaries reported in the Automated Central Tumor Registry Database (year of diagnosis range: 2001-18). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models following participants from their date of diagnosis until last contact or censoring, whichever occurred first. Multivariable models were adjusted for covariates selected a priori because of their known influence on risk of EOC death; age at diagnosis (continuous), histology, stage and receipt of the first course of chemotherapy treatment. We adjusted for year of diagnosis (continuous) to account for possible changes in treatment over time. Results: The study population included 1151 patients diagnosed with EOC: 796 NHW, 111 NHB, 130 AS, 49 PI and 65 Hispanic (HS). All EOC patients had complete information on age at diagnosis, stage and chemotherapy treatment. During a median (interquartile range) follow-up of 3.5 years (1.8-6.7), 702 EOC patients (61%) died of all causes. When comparing crude EOC patient characteristics by racial/ethnic group, NHW had the highest frequency of EOC leading to death (58% vs. &lt; 49% in other groups). There also were differences in histology; NHW and NHB had a higher frequency of serous tumors ( &gt; 56% of EOCs vs. &lt; 52% in other groups); PI had a high proportion of endometrioid histology (14% of EOCs vs. &lt; 11% in others); 10% of EOCs among AS had clear cell histology (vs. &lt; 9% in others). HS had a high percentage of local disease (23% vs. &lt; 20% in others). In multivariable survival analysis adjusting for clinical factors, we observed that compared with NHW, there were no differences in EOC survival by race/ethnicity: AS, HR = 0.80 (95% CI = 0.61-1.05); NHB, HR = 0.96 (95% CI = 0.72-1.28); PI, HR = 0.92 (95% CI = 0.58-1.46); and HS, HR = 0.82 (95% CI = 0.56-1.21). Conclusions: We observed no racial/ethnic disparities in EOC survival in a Military equal access treatment environment. These results highlight the importance of studying how differences in access to healthcare may impact observed racial/ethnic disparities for EOC.

Adverse Trends in Premature Cardiometabolic Mortality in the United States, 1999 to 2018.

BackgroundLife expectancy in the United States has recently declined, in part attributable to premature cardiometabolic mortality. We characterized national trends in premature cardiometabolic mortality, overall, and by race‐sex groups.Methods and ResultsUsing death certificates from the Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research, we quantified premature deaths (<65 years of age) from heart disease, cerebrovascular disease, and diabetes mellitus from 1999 to 2018. We calculated age‐adjusted mortality rates (AAMRs) and years of potential life lost (YPLL) from each cardiometabolic cause occurring at <65 years of age. We used Joinpoint regression to identify an inflection point in overall cardiometabolic AAMR trends. Average annual percent change in AAMRs and YPLL was quantified before and after the identified inflection point. From 1999 to 2018, annual premature deaths from heart disease (117 880 to 128 832), cerebrovascular disease (18 765 to 20 565), and diabetes mellitus (16 553 to 24 758) as an underlying cause of death increased. By 2018, 19.7% of all heart disease deaths, 13.9% of all cerebrovascular disease deaths, and 29.1% of all diabetes mellitus deaths were premature. AAMRs and YPLL from heart disease and cerebrovascular disease declined until the inflection point identified in 2011, then remained unchanged through 2018. Conversely, AAMRs and YPLL from diabetes mellitus did not change through 2011, then increased through 2018. Black men and women had higher AAMRs and greater YPLL for each cardiometabolic cause compared with White men and women, respectively.ConclusionsOver one‐fifth of cardiometabolic deaths occurred at <65 years of age. Recent stagnation in cardiometabolic AAMRs and YPLL are compounded by persistent racial disparities.

Trends in Heart Failure-related Cardiovascular Mortality in Rural Versus Urban Counties in the United States, 2011-2018

Introduction Mortality rates due to heart failure (HF) have increased since 2011, but estimates of heterogeneity at the county-level in HF-related mortality are not known. Differences between rural and urban counties and the impact of county-level factors on HF-related mortality are needed to inform public health strategies. Hypotheses Substantial variation in HF-related mortality trends between 2011-2018 exists by rural-urban designation. In addition, county-level factors account for a large proportion rural-urban differences in HF-related mortality rates. Methods We queried CDC WONDER to identify HF deaths between 2011-2018 defined as any mention of HF (I50) on the death certificate and cardiovascular disease (I00-78) as the underlying cause of death. First, we calculated age-adjusted mortality rates (AAMR) and examined trends stratified by rural-urban status (defined using 2013 NCHS Urban-Rural Classification Scheme), age (35-64 and 65-84 years), and race-sex subgroups per year. Second, we combined all deaths from 2011-2018 and estimated incidence rate ratios (IRR) in HF-related mortality for rural versus urban counties using multivariable negative binomial regression models with adjustment for sociodemographic factors, risk factor prevalence, and physician density. Results Between 2011-2018, AAMRs were consistently higher for rural compared with urban counties (e.g., 73.2 [95% CI: 72.2-74.2] vs. 57.2 [56.8-57.6] in 2018, respectively). The highest AAMR was observed in rural black men (131.1 [123.3-138.9] in 2018), and the greatest increases in HF-related mortality occurred in rural black men, age 35-64 years (+6.1%/year). Unadjusted models demonstrated significantly higher HF-related mortality in rural versus urban counties across the entire study period (IRR = 1.67 [95% CI: 1.57-1.78] and 1.16 [95% CI: 1.13-1.18] for younger and older adults, respectively). The rural-urban IRR was significantly attenuated after adjustment for county-level factors among both younger (1.10 [1.04-1.16]) and older adults (1.04 [1.02-1.07]). Conclusions Differences in county-level factors account for a significant amount of the observed variation in HF-related mortality between rural and urban counties.

Cervical cancer incidence and mortality rates in Kentucky

ObjectivesThe goal of this study was to assess how the incidence and mortality of cervical cancer in Kentucky has changed from 1995 through 2017. Additionally, trends in incidence and mortality across different geographic areas and between different races were evaluated. MethodsAge-adjusted annual incidence and mortality rates for cervical cancer were collected from the Kentucky Cancer Registry (KCR). A quadratic fit model was used to evaluate changes in the incidence and mortality over time and to compare differences in cervical cancer incidence and mortality by: 1) rural versus urban counties, 2) Appalachian versus non-Appalachian counties, and 3) black versus white women. ResultsOverall, the incidence of cervical cancer has significantly decreased throughout Kentucky since 1995. When comparing different geographic regions, the incidence was 14% and 23% higher in rural and Appalachian counties, respectively, compared to urban and non-Appalachian counties (p < 0.0001) throughout the study period. The incidence of cervical cancer was significantly higher in black women compared to white women from 1995 through 2007, but since 2008 there has been no significant difference in cervical cancer incidence based on race. Similar to incidence rates, mortality from cervical cancer was 29% higher in Appalachia (p = 0.0004) throughout the studied time period. Black women had higher age-adjusted mortality than white women until 2012, but since that time there has not been a significant difference in cervical cancer mortality based on race. ConclusionsWomen residing in rural and Appalachian Kentucky have higher cervical cancer incidence and mortality rates.

Are black and Hispanic persons disproportionately affected by COVID-19 because of higher obesity rates?

BackgroundOn March 13, 2020, the World Health Organization declared COVID-19 a pandemic. Shortly after that, it was reported that mortality rates in New York City (NYC), the epicenter of the pandemic in the United States, were found to be significantly higher in black and Hispanic populations.ObjectivesThe aim of this article is to evaluate the mortality rates in NYC among the different ethnic groups and the different boroughs as they relate to the obesity rates to see whether this issue merits further evaluation.SettingNYC.MethodsCOVID-19 data were obtained from the official New York authorities in relation to total number of cases in the different boroughs of NYC. Age-adjusted COVID-19–related mortality rates of the different ethnic groups were also obtained. These data were cross-compared with historic community health data on obesity rates previously published and also obesity rates among the different ethnic groups in NYC.ResultsThe 2 NYC boroughs that have the highest mortality rates are the Bronx (6%) and Brooklyn (5.4%). Both the Bronx and Brooklyn were also found to have the highest obesity rates at 32% and 27%, respectively. The 2 ethnic groups with the highest obesity rates (Hispanic and black) were also found to have the highest age-adjusted mortality rates per 100,000 compared with the other ethnic groups (22.8% and 19.8%, respectively).ConclusionsThe Hispanic and black populations in NYC seem to be disproportionately affected by the COVID-19 pandemic because of the higher incidence of mortality rates. Obesity may have played a role in the high incidence of mortality in those ethnic groups.

Analysis of the Breast Cancer Mortality Rate in Portugal Over a Decade: Spatiotemporal Clustering Analysis.

Breast cancer is the first cause of cancer-related death in Portuguese women. This study aimed to characterize femalebreast cancer mortality in Portugal in the period between 2002 and 2013, with a special focus on spatiotemporal patterns. The breast cancer mortality rate was studied using descriptive analysis (unadjusted and age-adjusted), andspatiotemporal clustering analyses. In 2002 - 2013 the breast cancer mortality rate was 28.47/100 000 inhabitants and the age-adjusted mortality rate was19.46/100 000 inhabitants. In this period the Lisbon region (urban), Alentejo and Algarve (rural) presented higher breast cancer mortalityrate, but Madeira (urban), Lisbon and Algarve had higher age-adjusted mortality rate. In the spatiotemporal analysis, the overallmortality rate showed an increasing trend of 1.218%/year, without spatial variations. Also, different patterns were detected in the < 50,50 - 64 and ≥ 65 age-groups (+ 0.725%, - 1.781% and + 0.896%, respectively). One temporal (2004 - 2006) and one spatiotemporalcluster (North coast) presented significantly lower mortality rate than expected for the period and/or area (26.2 and 16.1/100 000 inhabitants,respectively). Conversely, two spatiotemporal clusters, located in the city of Lisbon (2002 - 2007) and in the Centre region(2008 - 2013), presented significantly higher breast cancer mortality rate than expected (48.6 and 34.9/100 000 inhabitants, relativerisk: 1.74 and 1.26, respectively). The annual female crude and adjusted breast cancer mortality rate matched previous publications. However the annualincrease detected in the unadjusted rate clashes with the published literature. Overall, the presence of spatiotemporal clusters supportsthe uneven distribution of the breast cancer mortality reported previously in the different Portuguese regions. This study identified areas and trends of the female breast cancer mortality rate, showing high spatiotemporal variationsthat must support further detailed studies/interventions.

Abstract 15: Trends in Atrial Fibrillation-related Cardiovascular Mortality Rates in The United States: 1999-2017

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and the prevalence is increasing due to the aging of the population and the growing burden of vascular risk factors. Although deaths due to cardiovascular disease (CVD) death have dramatically decreased in recent years, trends in AF-related CVD death has not been previously investigated. Purpose: We sought to quantify trends in AF-related CVD death rates in the United States. Methods: AF-related CVD death was ascertained using the CDC WONDER online database. AF-related CVD deaths were identified by listing CVD (I00-I78) as underlying cause of death and AF (I48) as contributing cause of death among persons aged 35 to 84 years. We calculated age-adjusted mortality rates (AAMR) per 100,000 population, and examined trends over time estimating average annual percent change (AAPC) using Joinpoint Regression Program (National Cancer Institute). Subgroup analyses were performed to compare AAMRs by sex-race (black and white men and women) and across two age groups (younger: 35-64 years, older 65-84 years). Results: A total of 522,104 AF-related CVD deaths were identified between 1999 and 2017. AAMR increased from 16.0 to 22.2 per 100,000 from 1999 to 2017 with an acceleration following an inflection point in 2009. AAPC before 2009 was significantly lower than that after 2009 [0.4% (95% CI, 0.0 - 0.7) vs 3.5% (95% CI, 3.1 - 3.9), p &lt; 0.001). The increase of AAMR was observed across black and white men and women overall and in both age groups (FIGURE), with a more pronounced increase in black men and white men. Black men had the highest AAMR among the younger decedents, whereas white men had the highest AAMR among the older decedents. Conclusion: This study revealed that death rate for AF-related CVD has increased over the last two decades and that there are greater black-white disparities in younger decedents (&lt;65 years). Targeting equitable risk factor reduction that predisposes to AF and CVD mortality is needed to reduce observed health inequities.

Rural Health.

About one in five US residents-nearly 60million people-live in rural areas, which cover 97percent of the nation's land mass. People living in rural communities suffer disproportionately from adverse health outcomes, including poorer health, greater disability, and higher age-adjusted mortality. This month's DataGraphic illustrates some of the rural vs. urban differences in health outcomes.

Structural Urbanism Contributes To Poorer Health Outcomes For Rural America.

Rural populations disproportionately suffer from adverse health outcomes, including poorer health and higher age-adjusted mortality. We argue that these disparities are due in part to declining health care provider availability and accessibility in rural communities. Rural challenges are exacerbated by "structural urbanism"-elements of the current public health and health care systems that disadvantage rural communities. We suggest that biases in current models of health care funding, which treat health care as a service for an individual rather than as infrastructure for a population, are innately biased in favor of large populations. Until this bias is recognized, the development of viable models for care across the rural-urban continuum cannot move forward.

Mortality due to HIV/AIDS in Viet Nam: time trend and related socio-economic status in some populations and periods from 2005 to 2014

ABSTRACT The study examined mortality due to HIV/AIDS and its time trend and ecological variables of socio-economic status during 2005–2014. Mortality data were obtained from the database of population-based mortality registration. Five variables including name, age, sex, date of death, and cause of death were collected from 10,184 of 10,769 local state health centers. Mortality rates ratio and 95% confidence interval (MRR, 95%CI) were calculated to observe the risk of death from HIV/AIDS-related to socio-economic status and time trends. The age-adjusted HIV/AIDS mortality rate increased from 5.49 per 100,000 during 2005 to 6.03 during 2006 and 6.20 during 2007. An elevated risk of death was seen in high mountain districts in Nghe An province, adjusted MRR = 5.38, 95%, CI: 4.76–6.08 relative to the urban areas of Vinh and Cua Lo cities. The highest age-adjusted mortality rate (147.1 per 100,000) was observed in a commune located in Thai Nguyen province. There was a statically significant decrease in HIV/AIDS mortality in Nghe An province from 2005–2006 to 2013–2014 (p < 0.05). The findings suggest that people living with HIV/AIDS in disadvantaged regions have a higher risk of death but there was a significant decrease in HIV/AIDS mortality in Nghe An province by 2013–2014.

Geographic disparity in systemic sclerosis mortality in the United States: 1999-2017.

Previous studies reported a progressive decrease in the systemic sclerosis mortality rates in the United States from 1959 to 2002. Identification of areas with clusters of higher mortality rates is important to implement targeted interventions. In this study, we aimed to estimate the mortality rates of scleroderma and to analyze its geographic variability at the state level in the United States. Mortality rates of scleroderma from 1999 to 2017 were obtained from the CDC Wonder Underlying Cause of Death database and its query system, using International Classification of Diseases, Tenth Revision codes. Age-adjusted rates were calculated by state and demographics. A linear regression model was applied to evaluate trends over time. Over the period studied, a total of 24,525 deaths had scleroderma as the underlying cause of death. The age-adjusted mortality rate was 3.962 per million (95% CI: 3.912-4.012), decreasing progressively from 4.679 (95%CI: 4.423-4.934) in 1999 to 2.993 (95% CI: 2.817-3.170) per million in 2017. The age-adjusted mortality rate was 5.885 (95% CI: 5.802-5.967) and 1.651 (95% CI: 1.604-1.698) per million in females and males, respectively. Per races, the highest age-adjusted mortality rate was in Blacks or African Americans, at 5.703 per million (95% CI: 5.521-5.885), followed by American Indians or Alaska Native at 5.047 per million (95% CI: 4.428-5.667). Clusters of states with higher and lower mortality rates were identified. South Dakota had the highest whereas Hawaii had the lowest mortality rate. We found a trend to a progressive decrease in mortality rates of scleroderma during the years of our study. In addition, we found relevant state-by-state variation in mortality with several geographical clusters with higher mortality rates. Further analyses are warranted in order to better understand the factors associated with the observed geographic disparities.

Mortality From Heart Failure and Dementia in the United States: CDC WONDER 1999–2016

Heart failure and dementia are diseases of the elderly that result in billions of dollars in annual health care expenditure. With the aging of the United States population and increasing evidence of shared risk factors, there is a need to understand the conditions' shared contributions to nationwide mortality. The objectives of this study were to estimate the burden of mortality from heart failure and dementia and characterize the demographics of affected individuals. This retrospective study used National Vital Statistics Data from 1999 to 2016 provided by the Centers for Disease Control and International Classification of Diseases (10th edition) codes for heart failure and dementia as defined by the Medicare Chronic Conditions Data Warehouse. From 1999 to 2016, deaths contributed to by both heart failure and dementia totaled 214,706 and constituted 4.00% of all heart failure deaths and 9.04% of all dementia deaths. Women were more affected than men, with higher age-adjusted mortality rates (per 1,000,000 person-years): 38.67 (95% confidence interval [CI] 38.47-38.87) versus 32.90 (95% CI 32.65-33.15; P < .001). Whites were affected more than blacks, with age-adjusted mortality rates (per 1,000,000 person-years) of 38.00 (95% CI 37.83-38.16) versus 31.06 (95% CI 30.54-31.59; P < .001). However, under the age of 65 years, higher crude mortality rates (per 1,000,000 person-years) were reported in men (0.20, 95% CI 0.18-0.22) compared with women (0.15, 95% CI 0.13-0.16; P < .001). This study provides insight into temporal trends and nationwide mortality rates reported for heart failure and dementia. Our results suggest a disproportionate burden on populations over 85 years of age, whites, and women.