Urban-Rural Disparities in Cardiovascular Disease Mortality Rates Open Access

Dabhadkar, Kaustubh Chandrashekhar (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/w37637492?locale=en
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Abstract

Urban- Rural Disparities in Cardiovascular Disease Mortality Rates

Kaustubh Dabhadkar, MBBS


Abstract:
Background:
Cardiovascular diseases (CVD) continue to be the most important cause
of mortality throughout the United States (US). Although CVD mortality rates have
declined over the past two decades, it is unclear if the decline has been uniform across all
urbanization levels.


Objective: We evaluated mortality rates due to CVD over eight years (1999-2007) in
predefined US urbanization categories.


Methods: We used national-level mortality and population statistics from the National
Center for Health Statistics for years 1999-2007 among persons over 45 years. We
calculated crude and age-adjusted mortality rates in three predefined urbanization
categories (large metropolitan areas, small metropolitan areas, and rural areas) to study
the effect of urbanization level on mortality rates. We further modeled crude rates using
Poisson regression to compare rate ratios of mortality due to CVD in different
urbanization levels.


Results: In rural areas, CVD mortality rate continues to be higher than in metropolitan
areas (Adjusted RR 1.34; 95 % CI 1.33- 1.35). This has gone up from 1.27 (95 % CI 1.26-
1.28) in 1999. Thus, urbanization level was found to be an independent predictor of
mortality. Mortality rates in rural areas were higher than metropolitan areas in both
genders as well as all age-groups. We also observed a decline in deaths due to CVD as a
proportion of total deaths across the country, from 12.5 % in 1999 to 9.5 % in 2007.
However, the decline in mortality was more in large metropolitan areas compared to
small metropolitan and non-metropolitan areas. Age-group, race and gender differences
in the population explain some of the excessive rate, but still a considerable portion
remains unexplained.




Table of Contents



Table of Contents

Abstract: ......................................................................................................................................................... 1
Literature review ........................................................................................................................................... 2
Introduction: .................................................................................................................................................. 4
Methods: ......................................................................................................................................................... 5
Data source: .................................................................................................................. ............................ 5
Statistical analysis: ..................................................................................................................................... 6
Results: ............................................................................................................................................................ 7
Discussion: ..................................................................................................................................................... 9
References .................................................................................................................................................... 12
Tables ............................................................................................................................................................ 15
Table 1: CVD Mortality Rates for US Population by urbanization categories, 2007 . ................ 15
Table 2: Rate Ratio Estimates of CVD mortality From Poisson Regression Models by
Urbanization categories, Age group, Gender, and Race in United States, 1999 and 2007 ......... 16
Figures ....................................................................................................................... .................................. 17
Figure 1: Age-adjusted US CVD mortality rates by Urbanization Level, 1999-2007 ................. 17
Figure 2: CVD deaths as a percentage of total deaths, 1999-2007 ................................................. 18
Public Health Implications and future directions .................................................................................. 19


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