County-Level Variation in Cardiovascular Disease Mortality in the United States in 2009-2013: Comparative Assessment of Contributing Factors.

We examined factors responsible for variation in cardiovascular disease (CVD) mortality across US counties in 2009-2013. We linked county-level census, survey, administrative, and vital statistics data to examine 4 sets of features: demographic factors, social and economic factors, health-care utilization and features of the environment, and population health indicators. County-level associations of these features (standardized to a mean of 0 with a standard deviation of 1) with cardiovascular deaths per 100,000 person-years among adults aged 45-74 years was modeled using 2-level hierarchical linear regression with random intercept for state. The percentage of CVD mortality variation (intercounty disparity) modeled by each set of features was quantified. Demographic composition accounted for 36% of county CVD mortality variation, and another 32% was explained after inclusion of economic/social conditions. Health-care utilization, features of the environment, and health indicators explained an additional 6% of CVD mortality variation. The largest contributors to CVD mortality levels were median income (-23.61 deaths/100,000 person-years, 95% CI: -26.95, -20.26) and percentage without a high school education (20.71 deaths/100,000 person-years, 95% CI: 16.48, 24.94). In comparison, the largest health-related contributors were health-care utilization (19.35 deaths/100,000 person-years, 95% CI: 16.36, 22.34) and CVD risk factors (4.80 deaths/100,000 person-years, 95% CI: 2.14, 7.4...
Source: Am J Epidemiol - Category: Epidemiology Authors: Tags: Am J Epidemiol Source Type: research