Geographic patterns of CVD mortality in the U.S.A.

Cardiovascular disease (CVD) is commonly analyzed in the epidemiologic literature as a single large category, as sub-categories such as heart disease and stroke, or as single diagnoses such as hypertension or myocardial infarction. This analysis groups CVD mortality rates into three different groups: atherosclerosis-related CVD (ACVD), hypertension-related CVD (HCVD), and all other CVD diagnoses (OCVD). Mortality data from the National Vital Statistics Cooperative Program (National Center for Health Statistics) for the years 1960-1990 (by 10-year intervals) were placed into these three groupings and age adjusted. These data were examined by gender and race for all 50 states and the District of Columbia and then ranked, grouped into quintiles, and mapped. The patterns for ACVD, HCVD, and OCVD are different. The familiar clustering of high mortality rates in the southeastern U.S.A, is present for HCVD, but not for the other two groups. HCVD patterns for 1960-1990 are virtually unchanged, indicating no geographic shifting. For ACVD, the highest mortality rates clustered in the northeast coastal states of the U.S.A. in 1960. The decline in mortality was not uniform. For 1990, the states with the highest rates clustered along the Ohio and Mississippi Rivers. These discordant trends indicate that the etiologic patterns for HCVD and ACVD have varied in different parts of the United States. Ecological analyses and intervention efforts should be targeted to the specific profiles and needs of these geographic areas.