The Burden of Cardiovascular Diseases Among US States, 1990-2016.
Level 3 - non-randomized controlled study
Longitudinal population-level observational burden of disease and risk factor modeling.
PubMed 29641820 · doi:10.1001/jamacardio.2018.0385
What was done
Using Global Burden of Disease (GBD) methodology, researchers analyzed state-level cardiovascular disease (CVD) mortality, nonfatal health outcomes, and 12 risk factor groups across age groups and sexes in the United States from 1990 to 2016. Disease burden was quantified using disability-adjusted life-years (DALYs) across 10 categories of CVD alongside comparative risk assessment.
What was found
Between 1990 and 2016, age-standardized CVD DALYs decreased across all US states, though rates of decline varied markedly and burden began increasing in a small number of states in recent years. Men maintained approximately twice the CVD DALY burden of women. Ischemic heart disease remained the leading CVD cause across all states, while the second leading cause varied. Dietary risks accounted for the largest attributable CVD burden, followed by high systolic blood pressure, high body mass index, high total cholesterol, high fasting plasma glucose, tobacco smoking, and low physical activity. Additionally, risk-deleted CVD DALY rates increased between 2006 and 2016 in 16 states, pointing to unmeasured risk factors.
Why it matters
This study provides comprehensive, state-by-state tracking of CVD burden over 26 years, demonstrating that geographic health inequalities persist and are largely driven by modifiable metabolic, behavioral, and dietary risks.
Limits
The abstract reports relative trends and rankings rather than absolute DALY numbers or confidence intervals. Findings rely on statistical modeling of secondary vital statistics and survey datasets, aggregate to the state level (masking county or neighborhood disparities), and indicate that traditional risk factors fail to explain recent worsening trends in 16 states.
Cited by
- supports Cardiovascular disease is the leading cause of death in the United States.