Urban-Rural Disparities in Cardiovascular Disease Mortality Rates Público
Dabhadkar, Kaustubh Chandrashekhar (2011)
Published
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
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2
Introduction:
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4
Methods:
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5
Data source:
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............................ 5
Statistical analysis:
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6
Results:
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7
Discussion:
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9
References
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12
Tables
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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
About this Master's Thesis
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