Trends In Age-adjusted Mortality Rates Research Articles

Heart Failure-Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020.

Population-based data on heart failure (HF)-related death in patients with atrial fibrillation (AF) are lacking. We assessed HF-related death in people with AF in the United States over the past 21 years and examined differences by age, sex, race, ethnicity, urbanization, and census region. Data were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to determine trends in age-adjusted mortality rates per 100 000 people, due to HF-related death among subjects with AF aged ≥15 years. To calculate nationwide annual trends, we assessed the average annual percent change (AAPC) and annual percent change with relative 95% CIs using joinpoint regression. Between 1999 and 2020, 916 685 HF-related deaths (396 205 men and 520 480 women) occurred among US adults having a concomitant AF. The overall age-adjusted mortality rates increased (AAPC: +4.1% [95% CI, 3.8-4.4]; P<0.001), especially after 2011 (annual percent change, +6.8% [95% CI, 6.2-7.4]; P<0.001) in men (AAPC, +4.8% [95% CI, 4.4-5.1]; P<0.001), in White subjects (AAPC: +4.2% [95% CI, 3.9 to 4.6]; P<0.001) and in subjects aged <65 years (AAPC: +7.5% [95% CI, 6.7-8.4]; P<0.001). The higher percentage of deaths were registered in the South (32.8%). During the first year of the COVID-19 pandemic, a significant excess in HF-related deaths among patients with AF aged >65 years was observed. A worrying increase in the HF-related mortality rate among patients with AF has been observed in the United States over the past 2 decades.

Temporal Trends of Age-Adjusted Mortality Rates for Rheumatic Heart Disease in Brazil From 2000 to 2021.

Background Rheumatic heart disease (RHD) is a chronic cardiovascular condition stemming from an infectious origin, posing a substantial health burden, particularly in economically disadvantaged regions. It starts with acute rheumatic fever (ARF), a complication following group A Streptococcus infection, leading to heart valve damage and, over time, structural heart abnormalities. RHD contributes to premature deaths, especially in low-middle-income countries. Although the incidence and prevalence have generally reduced globally due to antibiotics and improved healthcare, it remains a significant public health concern in Brazil, echoing its prevalence in many developing nations around the world. RHD stands as a poignant testament to the intersection of socio-economic disparities and healthcare challenges within Brazil's diverse population. In Brazil, despite advancements in healthcare, RHD continues to impact communities, highlighting the urgent need for enhanced prevention strategies, access to quality healthcare services, and heightened awareness to combat this preventable, yet persistent, cardiac condition. Understanding the epidemiological landscape and socio-cultural factors influencing RHD in Brazil is crucial for developing targeted interventions aimed at mitigating its burden on individuals, families, and the healthcare system at large. Thus, our study focuses on analyzing age-related mortality rates linked to ARF and chronic RHD (ARHD) in Brazil from 2000 to 2021, particularly examining gender disparities. Materials and methods This retrospective cohort study employed a descriptive time-series approach, utilizing comprehensive nationwide data from Brazil spanning from 2000 to 2021 to assess trends in diverse age groups, among both sexes, enabling a detailed analysis of temporal patterns. Mortality data, extracted and categorized meticulously, were subjected to Joinpoint statistical analyses enabling comparative assessments, with average annual percent change (AAPC) and annual percent change (APC) serving as key metrics to quantify and interpret trends over the analyzed period. Results The acute RHD (ARHD)-related mortality declined over the analyzed years supported by AAPC, with higher mortality reduction in females. The age-adjusted mortality rate for "males and females" decreased from 78 to 67 deaths/100,000 from 2000 to 2021. Female mortality dropped from 85 to 69/100,000, and male mortality decreased from 73 to 63/100,000 over the same period. For ARHD, male age groups (20-29, 60-69, 70-79, 80+) showed declining mortality, while the 30-59 age group exhibited an upward. Females AAMR for chronic RHD (CRHD) decreased across all age groups, with significant reductions in the 80 years and above age group from 2000-2002 (APC: -11.94*) and steadily from 2002 onwards (APC: -1.33). Conclusions Our study revealed an overall decline in mortality rates for both acute and CRHD across both sexes. Females consistently exhibited higher mortality rates and a more pronounced reduction compared to males in both acute and CRHD. In ARHD, males experience the highest mortality in the 50-59 age group, while females have a peak in the 40-49 age group. The 60-69 age group had the highest mortality in CRHD for both sexes. Conversely, the 20-29 age group displayed the lowest mortality in CRHD, and the 80-89 age group had the lowest mortality in ARHD.

Prediction of early-onset colorectal cancer mortality rates in the United States using machine learning.

The current study, focusing on a significant US (United States) colorectal cancer (CRC) burden, employs machine learning for predicting future rates among young population. CDC WONDER data from 1999 to 2022 was analyzed for CRC-related mortality in patients younger than 56 years. Temporal trends in age-adjusted mortality rates (AAMRs) were assessed via Joinpoint software. Future mortality rates were forecasted using an optimal Autoregressive Integrated Moving Average (ARIMA) model. From 1999 to 2022, we observed 150,908 deaths with CRC listed as the underlying cause, predominantly in males, with an upward trend in AAMR. The ARIMA model projects an increase in CRC mortality by 2035, estimating an average annual percent change (AAPC) of 1.3% overall, 1% for females, and 1.5% for males. Our study findings emphasize the need for more robust preventive measures to reduce future CRC mortality among younger population. These results have significant implications for public health policies, particularly for males under 56, and underscore the importance of early screening and lifestyle modifications.

Abstract B143: Temporal trends in colorectal cancer mortality in the five regions of Georgia, 1975-2018: A Joinpoint regression analyses

Abstract Background: Colorectal cancer (CRC) is the third leading cause of death in Georgia. There remain significantly higher CRC mortality rates in the five public health regions of Georgia (Clayton, West Central, East Central, Southeast, and Northeast regions) in comparison to the rates in the State of Georgia. However, studies that examined temporal trends in CRC mortality rates in small geographic regions are still limited. The aim of this study was to analyze the time trends in mortality due to CRC within five regions of Georgia, stratified by age groups to assess any changes in mortality trends for the period 1975 -2018. Methods: Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat Database: Mortality - All COD, Aggregated with County, Total U.S. were used to select 1975-2018 CRC mortality data. We conducted Joinpoint regression analyses of the trends in age-adjusted mortality rates (ADMRs) due to CRC, stratified by the five regions of Georgia. Age differences in mortality were also examined. The average annual percent change (AAPC) and annual percent change (APC) with confidence intervals of 95% were calculated. Results: A total of 12,972 deaths from CRC were reported in these five regions during the period 1975-2018. The ADMR of CRC were 24.4, 24.9, 23.4, 22.7, and 25.7 per 100,000 in Clayton, East Central, Southeast, Northeast, and West Central regions, respectively. The mortality rates for CRC decreased from 1975 to 2018 in Clayton, Northeast, and Southeast regions (AAPC: -1.7% to -3.4%, p-value&amp;lt;0.05). One Joinpoint trend found a significant reduction in mortality in the East Central (1984-2018) (APC: -4.1%, p-value&amp;lt;0.001) and West Central (1981-2018) regions (APC: -3.2%, p-value=0.003). When examining age differences, patients aged 75 years or older had a significant decrease in mortality from 1975 to 2018 except in the East Central region (AAPC: -2.4% to -4.5%, p-value&amp;lt;0.05). In the East Central region, one Joinpoint demonstrated a significant decrease in mortality during 1987-2018 for the 60-74 age group and during 1984 -2018 for 75+ age group (APC: -5.1% &amp; -6.1%, respectively; both p-value&amp;lt;0.05). Reduced mortality rates were also found from 1984 to 2018 in the 60-74 age group in the Northeast region (APC: -4.3%, p-value&amp;lt;0.001). However, Northeast Georgians aged 15-59 years demonstrated a non-significant trend for increase in mortality from 1975 to 2018 (AAPC: 2.1%, p-value=0.181). Conclusion: The regional burden of colorectal cancer varied across the five regions of Georgia with CRC mortality rates decreased significantly in the Clayton, Northeast, and Southeast regions. Although reduced mortality rates were found in older patients in most regions, younger patients living in Northeast regions demonstrated a slight increase in mortality. Increased CRC risk awareness, culturally tailored prevention strategies through timely CRC screening uptake, and improved access to cancer treatment are extremely important to reduce the CRC burden, especially in the most affected regions in Georgia. Citation Format: Meng-Han Tsai, Daramola N. Cabral, Justin X. Moore, Jorge Cortes. Temporal trends in colorectal cancer mortality in the five regions of Georgia, 1975-2018: A Joinpoint regression analyses [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B143.

Abstract 15432: Racial and Sex Disparities in Age-Adjusted Mortality in COVID-19 Patients With Atrial Fibrillation in the United States

Introduction: While Coronavirus disease 2019 (COVID-19) primarily affects the respiratory system but can impact the cardiovascular system can triggering various complications. Hypothesis: To investigate the trend in age-adjusted mortality rates (AAMRs) in patients with atrial fibrillation(AF) among COVID-19-positive patients (CPP) by race and sex. Methods: Trends in AAMRs (per 100,000) from all-cause in patients with AF between April to December 2016-2020 were evaluated via the National Inpatient Sample and the US Census Bureau. The AAMRs among CPP with AF in 2020 was also evaluated between racial and sex cohorts. Results: A gradual rise in AAMR(all causes) in patients with AF was observed between 2016-2019, with a 49.4% overall rise between 2019(271 per 100,000) and 2020(405 per 100,000) ( Table 1a and Figure ). Around 250475 COVID-19-positive patients had AF, and 24.2% of cases did not survive their hospitalization (vs. 10.9% in those without AF, p&lt;0.01, aOR 1.457, 95% CI 1.438-1.477). Among CPP males and females with AF that died, White females and males were the oldest, while Black males and females reported the highest mean Charlson Comorbidity Index (CCI) score ( Table 1b ).Furthermore, among the CPP with AF in 2020, Hispanics reported a higher AAMR (119.6 per 100,000) than Whites(111.1 per 100,000) and Blacks(101.9 per 100,000). AAMRs in males were higher in Hispanic males (144.8 per 100,000), followed by White males (129.7 per 100,000), and Black males (110 per 100,000). However, the AAMRs in females were highest in Black females (91.3 per 100,000), followed by White females (88.3 per 100,000) and Hispanic females (87.0 per 100,000). ( Table 1c ) Conclusions: AAMRs in patients with AF are on the rise and a sharp growth was seen during the first year of the pandemic. AAMRs among CPP patients with AF were highest among Black females and Hispanic males, while White males and females were oldest and Black males and females reported the highest CCI scores.

Examining Trends in Kidney Cancer Mortality by Gender and Race in the United States: A 20-Year Analysis

Abstract Background Kidney cancer (KC) is a significant contributor to cancer mortality worldwide, with gender, racial, and ethnic disparities impacting outcomes. While previous studies have investigated the outcomes of diverse patient populations, gaps in knowledge remain. The incidence of KC has been rising steadily, and it is essential to understand the patterns of mortality to identify and address disparities in healthcare. Therefore, this study aimed to investigate trends in age-adjusted mortality rates (ASMR) by gender, race, and ethnicity in the US at national levels. Methods The Center for Disease Control Wonder database was used to extract national KC mortality data (ICD-10 C64) from 1999-2020. ASMR and 95% confidence intervals (CI) were extracted based on gender and race reported per 100,000 population. Absolute percentage changes were calculated. Joinpoint Command Line Version 4.5.0.1 was used to apply a Joinpoint regression analysis and calculate Average Annual Percentage Change (AAPC). IRB approval was not needed as CDC is an open-source database with de-identified information. Results Over twenty years, 284,224 KC deaths were reported, with an overall decrease in ASMR in recent years. Males had significantly higher ASMR throughout the study period, with a lower decrease than females. Female mortality rates for all racial and ethnic groups declined over the study period, with the largest decrease observed in American Indian/Alaskan Native females (-34.3%). However, American Indian/Alaskan Native females still had the highest mortality rates in 2020. Asian females had the lowest mortality rates throughout the study period, but they only decreased slightly (-8.3%). African American and white females had similar mortality rates that decreased by 25% and 22.2%, respectively. Among males, there was a general decline in mortality rates across all racial and ethnic groups, with the largest decrease observed in American Indian/Alaskan Native males (-44.3%). Despite having lower mortality rates than most other groups, White males had the highest age-adjusted mortality rate (ASMR) of 5.7 in 2020 due to the lack of significant decline. When considering the average annual percentage change (AAPC) over the entire period, the decline in mortality rate was statistically significant for all groups except Asian females. The AAPC ranged from -2.1% for American Indian/Alaskan Native females to -0.4% for Asian females. The steepest decline was observed in American Indian/Alaskan Native males (-2.1%), followed by American Indian/Alaskan Native females (-1.8%) and African American females (-1.7%). Conclusions In conclusion, our study highlights significant gender, racial, and ethnic disparities in kidney cancer mortality rates in the US. Our study underscores the importance of targeted interventions to reduce mortality rates among American Indian/Alaskan Native populations, who consistently had the highest mortality rates in kidney cancer throughout the study period. Additionally, our findings highlight the need for continued attention to male mortality rates at the gender level. The results of this study can inform healthcare policies and practices that aim to address the disparities in kidney cancer mortality rates and ultimately improve the health outcomes of all populations. CDMRP DOD Funding: no

Contemporary trends in mortality related to high-risk pulmonary embolism in US from 1999 to 2019

BackgroundPopulation-based data on high-risk pulmonary embolism (PE) mortality trends in the United States (US) are scant. ObjectivesTo assess current trends in US mortality related to high-risk PE over the past 21 years and determine differences by sex, race, ethnicity, age and census region. MethodsData were extracted from the Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER) to determine trends in age-adjusted mortality rates (AAMR) per 100,000 people, due to high-risk PE. To calculate nationwide annual trends, we assessed the average (AAPC) and annual percent change (APC) with relative 95 % confidence intervals (CIs) using Joinpoint regression. ResultsBetween 1999 and 2019, high-risk PE was listed as the underlying cause of death in 209,642 patients, corresponding to an AAMR of 3.01 per 100,000 people (95 % CI: 2.99 to 3.02). AAMR from high-risk PE remained stable from 1999 to 2007 [APC: −0.2 %, (95 % CI: −2.0 to 0.5, p = 0.22)] and then significantly increased [APC: 3.1 % (95 % CI: 2.6 to 3.6), p < 0.0001], especially in males [AAPC: 1.9 % (95 % CI: 1.4 to 2.4), p < 0.001 vs AAPC: 1.5 % (95 % CI: 1.1 to 2.2), p < 0.001]. AAMR increase was more pronounced in those <65 years, Black Americans, and residents of rural areas. ConclusionsIn an US population analysis, high-risk PE mortality rate increased, with racial, sex-based, and regional variations. Further studies are needed to understand root causes for these trends and to implement appropriate corrective strategies.

Kidney cancer mortality in the United States between 1999 and 2020: An observational analysis of outcomes by gender, race, and ethnicity.

4563 Background: Kidney cancer (KC) is one of the leading causes of cancer mortality, with recent data showing an increase in incidence and mortality worldwide. Gender, racial, and ethnic disparities can impact KC outcomes. Studies investigating the outcomes of diverse patient populations spanning the cytokine, targeted therapy and immunotherapy eras have been limited. This study aims to investigate trends in age-adjusted mortality rates (ASMR) by gender, race, and ethnicity in the US at national and state levels. Methods: We utilized the Center for Disease Control Wonder database to extract national and state-wide KC mortality data (ICD-10 C64) from 1999-2020. ASMR and 95% confidence intervals (CI) were extracted based on gender, race and ethnicity reported per 100,000 population. To evaluate the difference between metro and non-metro regions, we divided the national trends based on 2013 Urban NCHS Urban-Rural scheme. Joinpoint regression analysis was performed to evaluate trends. Results: In total, 284,224 KC deaths were reported over twenty years, with an overall decrease in ASMR in recent years. Males had significantly higher ASMR throughout the study period, with a lower decrease than females. Amongst racial groups, American Indians (AI) had the highest mortality in 1999 (5.7). However, due to the smaller decrease of ASMR in Whites compared to Non-Whites, Whites showed the highest ASMR (3.9) in 2020. According to ethnicity, Non-Hispanics Whites (NHW) had significantly higher ASMR than Hispanics in 1999 (4.0 vs. 3.5) and 2020 (3.5 vs. 3.0) with a similar rate of decline (-11.4% vs. -12.5%). State-wise, ASMR decreased in all states except Utah (+45.8%), Arkansas (+18.4%), Hawaii (+15.4%), Montana (+5.3), Kansas (+2.7) and Nevada (+2.6). Interestingly, non-metro regions showed higher ASMR throughout the study period. Also, while there was a steep decline in ASMR (15%) in metro regions, only a minimal decline (-4.7%) was observed in non-metro regions. Conclusions: Over the last two decades, there has been a decrease in the ASMRs across all genders, races and ethnicities and in most states in the USA. The decrease in ASMR is likely multifactorial, related to earlier detection and improved treatments. However, differences in outcomes by gender, race, and ethnicity persist, highlighting the need for strategies to better understand the etiology of differences and mitigate disparities across social determinants of health across gender, racial, and ethnic groups. [Table: see text]

Cardiogenic shock related cardiovascular disease mortality trends in US population: Heart failure vs. acute myocardial infarction as contributing causes

BackgroundObservational and trial data have revealed significant improvement in cardiogenic shock (CS) mortality due to acute myocardial infarction (AMI) after introducing early coronary revascularization. Less is known about CS mortality due to heart failure (HF), which is increasingly recognized as a distinct entity from AMI-CS. Methods and resultsIn this nationwide observational study, the CDC WONDER database was used to identify national trends in age-adjusted mortality rates (AAMR) due to CS (HF vs. AMI related) per 100,000 people aged 35–84.AAMR from AMI-CS decreased significantly from 1999 to 2009 (AAPC: -6.9% [95%CI -7.7, −6.1]) then stabilized from 2009 to 2020. By contrast, HF-CS associated AAMR rose steadily from 2009 to 2020 (AAPC: 13.3% [95%CI 11.4,15.2]). The mortality rate was almost twice as high in males compared to females in both AMI-CS and HF-CS throughout the study period. HF-CS mortality in the non-Hispanic Black population is increasing more quickly than that of the non-Hispanic White population (AAMR in 2020: 4.40 vs. 1.97 in 100,000). The AMI-CS mortality rate has been consistently higher in rural than urban areas (30% higher in 1999 and 28% higher in 2020). ConclusionsThese trends highlight the fact that HF-CS and AMI-CS represent distinct clinical entities. While mortality associated with AMI-CS has primarily declined over the last two decades, the mortality related to HF-CS has increased significantly, particularly over the last decade, and is increasing rapidly among individuals younger than 65. Accordingly, a dramatic change in the demographics of CS patients in modern intensive care units is expected.

Abstract 12877: National Trends of Atrial Fibrillation/Atrial Flutter Mortality in the United States From 1999 to 2019: Regional, Racial, and Gender Variations

Introduction: There is an emerging need to evaluate Atrial Fibrillation/Atrial Flutter (AF/AFL) mortality trends in different races and genders in different regions across the US. Methods: In an observational study utilizing the CDC WONDER database, age-adjusted mortality rates (AAMR) per 100,000 people for AF/AFL between 1999 and 2019 were investigated. Trends in AAMR were determined by evaluating average annual percentage changes (AAPC)s with Joinpoint regression analysis. Results: In the total US population from 1999 to 2019, AAMR due to AF/AFL has increased from 3.1 to 6.5 per 100,000 population. AF/AFL-related mortality rates have nearly doubled in all racial groups, ranging from an 84% increase in Black males (2.5 to 4.6 per 100,000) to a 123% increase in White males (3.1 to 6.9 per 100,000). AF/AFL-related mortality relative increase was highest in the West (140%) followed by Midwest (124%) and South (103%) while North East (81%) came last. Comparing white race mortality rates in different census regions, West demonstrated the highest increase in AAMR in the white population [170% in males, 138% in females]. Meanwhile, Midwest had the highest increase in the Black/African American population with a 111% increase in Females and 130% increase in Males. The Northeast showed the least increase in AAMR in both blacks and whites. Joinpoint analysis demonstrated that AF/AFL-related mortality rate has plateaued for black females and white males since 2017; the same plateau occurrence can be seen for white females since 2015 (Figure 1). Conclusion: The greatest increases in mortality occurred among white men and women and in Western states. AAMR increase has plateaued recently in white males as well as black and white females. AAPCs demonstrate that the rates of increases in AF mortality are greatest in Caucasians, followed by Asian and Black Americans.

Trends and Geographic Variation in Acute Respiratory Failure and ARDS Mortality in the United States

BackgroundDespite numerous advances in the understanding of the pathophysiology, progression, and management of acute respiratory failure (ARF) and ARDS, limited contemporary data are available on the mortality burden of ARF and ARDS in the United States.Research QuestionWhat are the contemporary trends and geographic variation in ARF and ARDS-related mortality in the United States?Study Design and MethodsA retrospective analysis of the National Center for Health Statistics’ nationwide mortality data was conducted to assess the ARF and ARDS-related mortality trends from 2014 through 2018 and the geographic distribution of ARF and ARDS-related deaths in 2018 for all American residents. Piecewise linear regression was used to evaluate the trends in age-adjusted mortality rates (AAMRs) in the overall population and various demographic subgroups of age, sex, race, urbanization, and region.ResultsAmong 1,434,349 ARF-related deaths and 52,958 ARDS-related deaths during the study period, the AAMR was highest in older individuals (≥ 65 years), non-Hispanic Black people, and those living in the nonmetropolitan region. The AAMR for ARF-related deaths (per 100,000 people) increased from 74.9 (95% CI, 74.6-75.2) in 2014 to 85.6 (95% CI, 85.3-85.9) in 2018 (annual percentage change [APC], 3.4 [95% CI, 2.2-4.6]; Ptrend = .003). The AAMR (per 100,000 people) for ARDS-related deaths was 3.2 (95% CI, 3.2-3.3) in 2014 and 3.0 (95% CI, 3.0-3.1 in 2018; APC, −0.9 [95% CI, −5.4 to 3.8]; Ptrend = .56). The observed increase in rates for ARF mortality was consistent across the subgroups of age, sex, race or ethnicity, urbanization status, and geographical region (Ptrend < .05 for all). The AAMR (per 100,000 people) for ARF (91.3 [95% CI, 90.8-91.8]) and ARDS-related mortality (3.3 [95% CI, 3.2-3.4]) in 2018 were highest in the South.InterpretationThe ARF-related mortality increased at approximately 3.4% annually, and ARDS-related mortality showed a lack of decline in the last 5 years. These data contextualize important health information to guide priorities for research, clinical care, and policy, especially during the coronavirus disease 2019 pandemic in the United States.

Trends in Hypertension Related Cardiovascular Mortality in The United States, 2000-2018

Background Despite targeted public health efforts, rates of hypertension (HTN) remain persistently high, and HTN control low with significant race-sex disparities. HTN infrequently causes death directly, but more commonly causes death through cardiovascular diseases (CVD), such as ischemic heart disease (IHD), heart failure (HF), and cerebrovascular disease. To comprehensively estimate the burden of HTN and inform prevention strategies, we determined trends in HTN-related CVD deaths overall and stratified by CVD subtypes in the United States. Methods Age-adjusted mortality rates (AAMR) were calculated based on death certificates of US residents ≥25 years (y) with any mention of HTN and CVD listed as the underlying cause of death between 2000-2018 (CDC WONDER). Joinpoint software identified inflection points in AAMR for HTN-related CVD. Trends in AAMR (average annual percentage change [AAPC, 95% CI]) of HTN-related CVD deaths as well as stratified by CVD subtype: IHD, HF, and cerebrovascular disease were calculated. All analyses were performed in all decedents and stratified by race-sex subgroups. AAMR rate-ratios (95% CI) of HTN-related CVD deaths in black compared with white men and women were calculated for 2018. Results Between 2000-2018, the AAMR of HTN-related CVD deaths increased by +0.5%/y (0.1, 0.8). A triphasic pattern in overall HTN-related CVD AAMR was identified (FIGURE): between 2000-2003, AAMR increased (+2.2%/y [0.4, 4.0]), between 2003-2012 AAMR decreased (-0.9%/y [-1.3, -0.5]), and between 2012-2018 AAMR increased again (+1.7%/y [1.1, 2.3]). Trends differed by CVD-subtype. The AAMR for HTN-related- IHD deaths declined -1.5 % /y (-1.8, -1.1), HF deaths increased 1.8%/y (1.4, 2.3), and cerebrovascular deaths remained stable -0.1%/year (-0.4, 0.2) between 2000-2018. For all CVD-subtypes AAMR increased in the most recent period (2012-2018) with significant disparities by race-sex. In 2018, AAMR of HTN-related CVD was 1.76 (1.73, 1.80) and 1.63 (1.60, 1.66) times higher in black compared with white men and women, respectively. Conclusions Since 2000, the AAMR for HTN-related CVD deaths has increased, particularly for HTN-related HF deaths. Trends consistently worsened between 2012-2018, with persistent racial disparities. Resources aimed at preventing and managing HTN are urgently needed to equitably reduce preventable CVD deaths. Despite targeted public health efforts, rates of hypertension (HTN) remain persistently high, and HTN control low with significant race-sex disparities. HTN infrequently causes death directly, but more commonly causes death through cardiovascular diseases (CVD), such as ischemic heart disease (IHD), heart failure (HF), and cerebrovascular disease. To comprehensively estimate the burden of HTN and inform prevention strategies, we determined trends in HTN-related CVD deaths overall and stratified by CVD subtypes in the United States. Age-adjusted mortality rates (AAMR) were calculated based on death certificates of US residents ≥25 years (y) with any mention of HTN and CVD listed as the underlying cause of death between 2000-2018 (CDC WONDER). Joinpoint software identified inflection points in AAMR for HTN-related CVD. Trends in AAMR (average annual percentage change [AAPC, 95% CI]) of HTN-related CVD deaths as well as stratified by CVD subtype: IHD, HF, and cerebrovascular disease were calculated. All analyses were performed in all decedents and stratified by race-sex subgroups. AAMR rate-ratios (95% CI) of HTN-related CVD deaths in black compared with white men and women were calculated for 2018. Between 2000-2018, the AAMR of HTN-related CVD deaths increased by +0.5%/y (0.1, 0.8). A triphasic pattern in overall HTN-related CVD AAMR was identified (FIGURE): between 2000-2003, AAMR increased (+2.2%/y [0.4, 4.0]), between 2003-2012 AAMR decreased (-0.9%/y [-1.3, -0.5]), and between 2012-2018 AAMR increased again (+1.7%/y [1.1, 2.3]). Trends differed by CVD-subtype. The AAMR for HTN-related- IHD deaths declined -1.5 % /y (-1.8, -1.1), HF deaths increased 1.8%/y (1.4, 2.3), and cerebrovascular deaths remained stable -0.1%/year (-0.4, 0.2) between 2000-2018. For all CVD-subtypes AAMR increased in the most recent period (2012-2018) with significant disparities by race-sex. In 2018, AAMR of HTN-related CVD was 1.76 (1.73, 1.80) and 1.63 (1.60, 1.66) times higher in black compared with white men and women, respectively. Since 2000, the AAMR for HTN-related CVD deaths has increased, particularly for HTN-related HF deaths. Trends consistently worsened between 2012-2018, with persistent racial disparities. Resources aimed at preventing and managing HTN are urgently needed to equitably reduce preventable CVD deaths.

Mortality Trends of Idiopathic Pulmonary Fibrosis in the United States From 2004 Through 2017

The burden of idiopathic pulmonary fibrosis (IPF)-related mortality in the United States in recent years is not well characterized. What are the trends in IPF-related mortality rates in the United States from 2004 through 2017? We used the Multiple Cause of Death Database available through the Centers for Disease Control and Prevention website, which contains data from all deceased US residents. IPF-related deaths were identified using International Classification of Diseases, 10th revision, codes. We examined annual trends in age-adjusted mortality rates stratified by age, sex, race, and state of residence. We also evaluated trends in place of death and underlying cause of death. From 2004 through 2017, the age-adjusted mortality decreased by 4.1%in men (from 75.5 deaths/1,000,000 in 2004 to 72.4 deaths/1,000,000 in 2017) and by 13.4%in women (from 46.3 deaths/1,000,000 in 2004 to 40.1 deaths/1,000,000 in 2017). This overall decrease was driven mainly by a decline in IPF-related mortality in patients younger than 85 years. The decreasing trend also was noted in all races except White men, in whom the rate remained stable. The most common cause of death was pulmonary fibrosis. The percentage of deaths occurring in the inpatient setting and nursing homes decreased, whereas the percentage of deaths occurring at home and hospice increased. From 2004 through 2017, the IPF age-adjusted mortality rates decreased. This may be explained partly by a decline in smoking in the United States, but further research is needed to evaluate other environmental and genetic contributors.

Trends in Age-Adjusted Mortality Rates for Pulmonary Embolism in the United States, 1999-2017

Background: Pulmonary embolism (PE) is an important cause of morbidity and mortality and represents one of the most common causes of cardiovascular death after myocardial infarction and stroke. Despite advances in the management of PE over the past decade, it is unknown whether mortality from PE has significantly changed. Therefore, our objective was to describe trends in death rates due to PE in the United States from 1999-2017, as well as to examine mortality trends by age, sex and race. Methods: We used death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research from January 1, 1999, to December 31, 2017, to calculate age-adjusted mortality rates (AAMR) per 100,000 population for PE (ICD-10 code I26) listed as underlying cause of death. AAMRs were examined overall, as well as by age (25-64 years versus 65-85 years) and sex/race groups. The Joinpoint Regression Program (National Cancer Institute) was used to identify up to one inflection point in AAMR trends. Statistical trends and average annual percent change (AAPC) were examined over the study period. Results: Between 1999 and 2017, there were 152,463 deaths attributable to PE as underlying cause of death. AAMR due to PE experienced an inflection point in 2009. AAMR was 3.3, 2.2, and 2.3 per 100,000 in 1999, 2009, and 2017, respectively. Trends in PE mortality rates reversed after the inflection point, with an AAPC before 2009 of -4.2% (-5.4, -3.0, p&amp;lt;0.001), indicating reduction in AAMR of 4.2% per year between 1999 to 2009, versus AAPC of +0.9% (0.3, 1.5, p&amp;lt;0.001) after 2009. When examined by age group (25-64, 65-84 years), the AAMR decreased between 1999 to 2009 for both age groups. Between 2009-2017, the AAMR for older adults (65-84 years) plateaued (AAPC 0.4% (-0.3, 1.1), while the AAMR for younger adults (25-64 years) increased (AAPC 2.4% (1.6, 3.1). Examination by sex/race groups demonstrated similar patterns of change with decrease in AAMR between 1999-2009 and plateau or increase in AAMR after 2009 (Table). Throughout the study period, black men and women had approximately a 2-fold higher AAMR compared to white men and white women. Conclusion: We provide contemporary nationwide estimates of trends in PE mortality over the last 18 years. In the past decade, death rates due to PE have become stagnant, reversing the trend from the prior decade where mortality rates were decreasing. Premature death attributable to PE showed a rising trend, which may be driving the overall reversal during the study period. Furthermore, racial disparities exist in mortality due to PE, with black men and women consistently having higher AAMR compared to white men and women. Identification of the underlying cause of the plateau in mortality rates and persistently observed disparities are needed in order to improve outcomes related to PE equitably and prevent reversal toward increasing mortality trend due to PE. Disclosures No relevant conflicts of interest to declare.

REDUCING HEALTH DISPARITIES IN THE ERA OF VALUE-BASED CARE

The US health care system is at a critical moment of transformation. The implementation of value-based models has made significant progress towards improving care quality and coordination, continuity of care and reducing cost. However, concerns have been raised regarding “cherry-picking” healthier people that may negatively impact patients with more complex needs and minority populations. Given that the US is becoming more diverse, there is a need for understanding the impact of social risk factors including ethnicity, immigration status, income and geography on health outcomes and issues of health care disparities. This panel brings together four studies that examine these phenomena in minority populations. These studies will provide novel insight regarding 1) healthcare utilization in Mexican-American Medicare beneficiaries and showing that social determinants of health are associated with a higher risk of hospitalization, emergency room admissions, and outpatient visits. 2) Mortality rates and predialysis care among Hispanics in the US, Hispanics in Puerto Rico, and Whites in the US demonstrating substantial disparities in access to recommended nephrology care for Hispanics in Puerto Rico; 3) Trends in age-adjusted mortality rates and supply of physicians in states with different nurse-practitioners regulation. 4) The impact of social risk factors on disenrollment from Fee-For-Service and enrollment in a Medicare Advantage plan in older Mexican-Americans. 5) Racial disparities in access to physician visits, prescription drugs, and healthcare spending among older adults with cognitive limitation. Studies in this panel will also discuss the effects of changes in care delivery and payment innovations in improving health equity.

Sex-specific mortality trends in adolescents and young adults with cancer from 2007 to 2016.

1570 Background: Adolescents and young adults (AYA) aged 15-39 years make up approximately 70,000 new oncology cases in the USA. Historically, mortality from cancer has smaller incremental improvements in AYA patients when compared to children and older adults, and not much is known about current sex-specific trends. We assessed overall and sex specific AYA mortality for the last 10 years (2007-2016). Methods: Trends in age-adjusted mortality rates per 100,000 (1972-2016) were obtained from the CDC’s National Center for Health Statistics (NCHS). Average annual percent changes (AAPCs) in relative survival were analyzed using NCI’s JPSurv webtool and mortality AAPCs were quantified using Joinpoint regression analysis. Results: Overall declines in mortality are similar in AYA men and women from 1972-2016, with 54% and 51% decline, respectively. In the most recent 10 years of data (2007 to 2016), combined sex AYA mortality AAPC’s declined by about 0.8% per year, slightly slower than declines in children &lt;15 years (1.3% per year) and adults ages &gt;40 years (1.5% per year). Among AYA males there have been 10 year AAPC mortality declines in leukemia (-1.8%), Hodgkin lymphoma (HL) (-5.1%), Non-Hodgkin lymphoma (NHL) (-4.1%) and melanoma of the skin (-3.4%). For AYA females, 10 year AAPC mortality declines occurred in leukemia (-1.9%), ovarian (-1.5%), HL (-10%), NHL (-4.9%) and melanoma (-2.8%). These declines have been offset by stable or increasing mortality rates for several common AYA cancers, including colorectal cancer (CRC) (1.1%) and bone and joint cancer (0.6%) in AYA males. AYA females have experienced mortality increases for CRC (0.6%), bone and joint cancer (0.5%) and uterine corpus cancer (2.8%). Conclusions: In general, mortality rates for both AYA men and women have declined over the past 10 years due to decreased mortality in hematologic malignancies and melanoma. Despite overall improvement, tumor categories in both AYA males and female such as CRC, bone and joint cancer, and uterine corpus cancers show increasing mortality. These diseases require specific investigations by both pediatric and adult researchers.

Age-adjusted Mortality Rates of Neoplasms and Circulatory System Diseases and Their Demographic Factors in Slovak Regions during 1996-2013.

Knowledge of the causes of deaths in Slovakia is lacking. This is significant because diet and lifestyle factors are different in central Europe compared to Western, Northern and Southern Europe. This study aims to discern trends of age-adjusted mortality rates caused by various diseases in relation to demographic factors. The aim of our study was to find certain statistical aspects including trends of age-adjusted mortality rates caused by neoplastic (Chapter II) and circulatory diseases (Chapter IX) in the Slovak population in relation to available demographic factors (sex, region and calendar year of death). Dataset of individual deaths in Slovakia with certain demographic factors (sex, region and calendar year of death) during 1996-2013 were provided by the Slovak National Center of Health Informatics. Regression and correlation analyses and analyses of variance and of covariance were used to yield the level of significance. We found significant differences of age-adjusted mortality rates between men and women, between Chapter II and Chapter IX and among Slovak regions. Age-adjusted mortality rates decline significantly in most regions for both sexes with the exception of stagnation in four regions in a group of Chapter II women (Košice, Nitra, Trenčín and Žilina) and one region in Chapter IX, also in group of women (Žilina). Mortalities caused either by Chapter II or Chapter IX diseases are significantly dependent on chapter, sex and region with mortalities either declining or stagnating.

Recent Trends in Cardiovascular Mortality in the United States and Public Health Goals.

Heart disease (HD) and cancer are the 2 leading causes of death in the United States. During the first decade of the 21st century, HD mortality declined at a much greater rate than cancer mortality and it appeared that cancer would overtake HD as the leading cause of death. To determine whether changes in national trends had occurred in recent years in mortality rates due to all cardiovascular disease (CVD), HD, stroke, and cancer and to evaluate the gap between mortality rates from HD and cancer. The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research data system was used to determine national trends in age-adjusted mortality rates due to all CVD, HD, stroke, and cancer from January 1, 2000, to December 31, 2011, and January 1, 2011, to December 31, 2014, overall, by sex, and by race/ethnicity. The present study was conducted from December 30, 2105, to January 18, 2016. Comparison of annual rates of change and trend in gap between HD and cancer mortality rates. The rate of the decline in all CVD, HD, and stroke mortality decelerated substantially after 2011, and the rate of decline for cancer mortality remained relatively stable. Reported as percentage (95% CI), the annual rates of decline for 2000-2011 were 3.79% (3.61% to 3.97%), 3.69% (3.51% to 3.87%), 4.53% (4.34% to 4.72%), and 1.49% (1.37% to 1.60%) for all CVD, HD, stroke, and cancer mortality, respectively; the rates for 2011-2014 were 0.65% (-0.18% to 1.47%), 0.76% (-0.06% to 1.58%), 0.37% (-0.53% to 1.27%), and 1.55% (1.07% to 2.04%), respectively. Deceleration of the decline in all CVD mortality rates occurred in males, females, and all race/ethnicity groups. For example, the annual rates of decline for total CVD mortality for 2000-2011 were 3.69% (3.48% to 3.89%) for males and 3.98% (3.81% to 4.14%) for females; for 2011-2014, the rates were 0.23% (-0.71% to 1.16%) and 1.17% (0.41% to 1.93%), respectively. The gap between HD and cancer mortality persisted. Deceleration in the decline of all CVD, HD, and stroke mortality rates has occurred since 2011. If this trend continues, strategic goals for lowering the burden of CVD set by the American Heart Association and the Million Hearts Initiative may not be reached.

Study of colorectal mortality in the Andalusian population

to provide up-to-date information and to analyze recent changes in colorectal cancer mortality trends in Andalusia during the period of 1980-2008 using joinpoint regression models. age- and sex-specific colorectal cancer deaths were taken from the official vital statistics published by the Instituto de Estadística de Andalucía for the years 1980 to 2008. We computed age-specific rates for each 5-year age group and calendar year and age-standardized mortality rates per 100,000 men and women. A joinpoint regression analysis was used for trend analysis of standardized rates. Joinpoint regression analysis was used to identify the years when a significant change in the linear slope of the temporal trend occurred. The best fitting points (the "join-points") are chosen where the rate significantly changes. mortality from colorectal cancer in Andalusia during the period studied has increased, from 277 deaths in 1980 to 1,227 in 2008 in men, and from 333 to 805 deaths in women. Adjusted overall colorectal cancer mortality rates increased from 7.7 to 17.0 deaths per 100,000 person-years in men and from 6.6 to 9.0 per 100,000 person-years in women Changes in mortality did not evolve similarly for men and women. Age-specific CRC mortality rates are lower in women than in men, which imply that women reach comparable levels of colorectal cancer mortality at higher ages than men. sex differences for colorectal cancer mortality have been widening in the last decade in Andalusia. In spite of the decreasing trends in age-adjusted mortality rates in women, incidence rates and the absolute numbers of deaths are still increasing, largely because of the aging of the population. Consequently, colorectal cancer still has a large impact on health care services, and this impact will continue to increase for many more years.