CVD Burden by US States 1990-2016

May 2018

The Burden of Cardiovascular Diseases Among US States, 1990-2016

Global Burden of Cardiovascular Diseases Collaboration

Article Information

JAMA Cardiol. 2018;3(5):375-389. doi:10.1001/jamacardio.2018.0385

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Key Points

Question  How does the total burden of cardiovascular diseases vary across US states?

Findings  In this study using the Global Burden of Disease methodology, large disparities in total burden of CVD were found between US states despite marked improvements in CVD burden.

Meaning  These estimates can provide a benchmark for states working to focus on key risk factors, improve health care quality, and lower health care costs.

Abstract

.Results  Between 1990 and 2016, age-standardized CVD DALYs for all states decreased. Several states had large rises in their relative rank ordering for total CVD DALYs among states, including Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa. The rate of decline varied widely across states, and CVD burden increased for a small number of states in the most recent years. Cardiovascular disease DALYs remained twice as large among men compared with women. Ischemic heart disease was the leading cause of CVD DALYs in all states, but the second most common varied by state. Trends were driven by 12 groups of risk factors, with the largest attributable CVD burden due to dietary risk exposures followed by high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity. Increases in risk-deleted CVD DALY rates between 2006 and 2016 in 16 states suggest additional unmeasured risks beyond these traditional factors.

Conclusions and Relevance  Large disparities in total burden of CVD persist between US states despite marked improvements in CVD burden. Differences in CVD burden are largely attributable to modifiable risk exposures.