Changes in coronary heart disease incidence and mortality in New Jersey 2000-2017
Creators: name: Tuppo, Ehab Elias
Publisher: name: No Publisher Supplied
Year: 2019

description: Even though coronary heart disease (CHD) incidence and mortality has been declining for several decades, it continues to be the number one cause of death in the United States. This decline has been shown to occur in all age, gender and racial/ethnic groups but not in equal measures. However, recent studies have shown a slowing or a taper in the decline in CHD incidence and mortality. We used data from the Myocardial Infarction Surveillance System (MIDAS), a statewide hospitalization database in New Jersey that contains all hospital discharge abstracts submitted to the New Jersey Hospital Discharge Data Collection System by nonfederal acute care hospitals in the state to update trends in incidence and New Jersey State Health Assessment Data from the Department of Health to examine mortality trends through 2017. We specifically looked at CHD and myocardial infarction (MI) data to see how the landscape of CHD has changed between 2000 and 2017 in the state. In chapter 1 we reviewed what the landscape of CHD is at the present. This included the decline that has occurred in CHD and a review of the probable reasons for the remarkable improvement over the last several decades. In chapter 2 we were interested in determining if the decline in CHD mortality has been steady from 2000 through 2017 and whether it has been similar in men and women, in blacks, whites and Hispanics and in different age groups. Outcomes were analyzed in total and in major demographic strata: for the three race/ethnic groups; for men and women; and for those 40-44, 45-49, 50-54, 55-59, 60-64, 65-69 , 70-74, 75-79 and 80-84 years of age. The results showed that there was an overall decline of more than 50% over the time period. The rate of CHD death declined similarly in each of the demographic subgroups. However, the decline was more robust in those over age 64 than in younger age groups and more in females than males. One concerning result was that most of the decline in CHD mortality occurred early in the study period with an attenuation of this decline that occurred in 2008-2009 and after. This attenuation may be due to the plateauing in the use of interventional and pharmacological therapies and/or by the increase in the rate of some cardiovascular risk factors, especially diabetes mellitus and obesity.In chapter 3, we examined the continuing trends in the incidence of hospitalizations for myocardial infarction (MI) in the years 2000-2014 and the case fatality rates for first hospitalizations for MI at discharge, by one year post admission, and by five years post admission using data from MIDAS. Outcomes were analyzed in total and in major demographic strata: for men and women; for whites and black and for those 40-44, 45-49, 50-54, 55-59, 60-64, 65-69 , 70-74, 75-79 and 80-84 years of age. We also wanted to see if the decline in mortality described in Chapter 2 may be partly explained by a decline in incidence of MI, and if so whether the two trends are strongly correlated in terms of demographic distribution and timing. Results show that there was an overall decline of more than 30% in the rate of first MIs from the year 2000 to 2014 but as seen in chapter 2, most of the decline occurred before 2009. Males had a higher incidence of first MIs through the study period, but they also had a greater decline in the incidence rate than females. A decline in MI incidence was observed in all but the youngest age groups with the most dramatic decline seen in the 80-84 age group. A decline of more than 30% was seen in the hospital MI case fatality rate in the population during this period. This was seen in all the demographic strata. Interestingly, women had a higher in-hospital death rate than men at the beginning of the study period, but by 2014 the steeper decline in women resulted in a lower hospital fatality rate than in men. The decline was similar between the racial groups. The oldest age groups exhibited more pronounced declines than the younger age groups. The 1 year case fatality rate showed a decline of almost 16% over the time period. This was seen in all demographic strata. Females showed a greater decline in the one year MI fatality rate than males. The oldest age groups had greater decline than the younger age groups. No significant decline in mortality was seen at 5 years after an initial MI. Similar non-significant results were seen when the data was broken down by gender, race and age groups. This lack of decline at five years may be due to competing risks with non-cardiovascular causes of death that could obscure any improvements in CHD deaths.In chapter 4 we wanted to determine the cause of the fall in mortality, whether this was more due to the effect of primary prevention (dietary change, physical activity, and the reduction in cholesterol and blood pressure) or from the effect of modern invasive medical or surgical treatment. Using the same demographic strata as used in chapter 3, we quantified and compared the decline in out of hospital CHD deaths per 100,000 in persons with no history of hospitalized CHD in the previous 10 years to the decline in fatalities among those who did have a CHD hospitalization in the 10 years prior to death. The study showed a decline in both populations and across all demographic strata but the decline in CHD mortality was larger in those without a prior hospitalization for CHD than in those with such hospitalization(s). This provides more evidence of the importance of improved lifestyle and out-patient care in accounting for the falling rates of coronary heart disease. The majority of those who died, more than 73%, did not have a history of CHD. This is very concerning and provides an opportunity from where further improvements could come from in the future.