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Introduction

Recent Trends in Coronary Heart Disease (CHD) Deaths Among the Elderly in the United States Emir Veledar PhD, Ambar Kulshreshtha MD MPh , Stephen Williams MD, Leslee Shaw PhD, Reza Fazel MD, Viola Vaccarino MD PhD. Introduction.

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Introduction

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  1. Recent Trends in Coronary Heart Disease (CHD) Deaths Among the Elderly in the United StatesEmir Veledar PhD, Ambar Kulshreshtha MD MPh, Stephen Williams MD, Leslee Shaw PhD, Reza Fazel MD, Viola Vaccarino MD PhD

  2. Introduction • Total mortality rates and coronary heart disease (CHD) mortality rates are declining in the USA. • Accordingly, the oldest individuals (85+ years) comprise the fastest growing segment of the population. • How do these declines in mortality apply to and re-apportion other age groups?

  3. Introduction • We examined trends in CHD mortality for the USA population over 25 years of age, focusing on changes occurring among individuals 65-74 and 75-84 years of age (the so called “elderly”).

  4. Methods • Using CDC Wonder we extracted data for the period between 1999 and 2006 from the National Center for Health Statistics data base for the entire population -- and for Caucasian and African American (AA) males and females -- starting from age 25 years is groups of 10 years. • For each group we determined number of individuals, all causes mortality, and deaths from CHD. • CHD deaths were defined as deaths classified in subgroup I20-I25, encompassing more than 90% of all deaths in ICD-10 section, “Diseases of the circulatory system.”

  5. Statistical analysis • Log link Poisson regression was used to derive race-and-gender- specific trends after adjusting for age. • When we wish to determine the effects of groups or exposure levels, we do this using the standardized mortality ratio (SMR). • The SMR is defined as the ratio of two rates. Male-to-female and AA versus Caucasian SMR were calculated. • We created one model for all 8 years, 8 models for each year, and 16 models for 8 years and 2 races. • This allowed us to estimate not only the time component but also gender difference by race.

  6. Graphs Five sets of graphs and included numerical data are presented: • Number of CHD deaths for each year from 1999 to 2006. • Annual decrease in deaths in each year compared to year 1999. • Percent change in deaths in each year compared to year 1999.

  7. Whole population

  8. Whole population

  9. Whole population

  10. African American females

  11. African American females

  12. Caucasian female

  13. Caucasian Females

  14. African American males

  15. African American males

  16. Caucasian males

  17. Caucasian males

  18. Results for whole population • CHD death rates between 1999 and 2006 among Caucasians and African Americans in the United States demonstrate an decline in all 4 groups. • Over 8 years, the overall decline in mortality from CHD deaths was 25.2 % in females and 19.5% in males. • Multivariable analysis showed a significant decrease in CHD mortality across time (p<.001), race (p<.001) and gender (p<.001). • SMR for gender was 1.67 indicating that rate for males was 67% higher then for females. SMR for race (AA versus Caucasian) was 1.23.

  19. Results for elderly • Decline in CHD deaths for groups 65-74 years and 75-84 years for Caucasian females was (35% and 32%); for AA females (36% and 32%). Deaths among males, both Caucasians (35% and 30%) and African Americans (27% and 22%), declined. • We observed graphically and demonstrated in models that mortality trends for the elderly population differ significantly from mortality trends in other groups.

  20. Results summary • Compared to 1999, more than 104,000 additional Americans with CHD survived in 2006 . • More than 76,000 (73% ) of the additional people surviving CHD annually are between 65 to 85 years old, a group located between the “baby boomers” and the “oldest old” but representing only 11% of the USA population. • Improved survival rates in this group is the major determinant of the unprecedented decline in mortality from CHD in the USA. • Mortality among the elderly contributed 50% to overall CHD deaths in 1999 but only 45% in 2006.

  21. Discussion • The trend of decreasing mortality from CHD in USA, not seen in other countries has apparently accelerated during the last 8 years. • CHD death rates have declined almost twofold between 1999 and 2006 when compared to the previous 8 years. • (Source: "Heart Disease and Stroke Statistics — 2009 Update" )

  22. Conclusion • Decline in CHD death rates in the elderly population (65 to 84 years) is an important contributor to the growing population aged 85 years and older as well as for the dramatic decline in CHD death rates for the overall population of the United States. • Despite these trends toward greater longevity, substantial racial and gender differences persist.

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