Publication date: 
April 11, 2018

Early death and illness decreased across all states over 26-year period, but gaps among states changed little

SEATTLE – States whose residents suffered from high rates of cardiovascular disease (CVD) a generation ago are now achieving much higher levels of healthy life, according to the most extensive state-by-state health study ever conducted.

In 2016, Kentucky, West Virginia, Alabama, Arkansas, Louisiana, Tennessee, and Oklahoma, achieved levels of cardiovascular burden comparable to the 1990 levels for Massachusetts, Connecticut, and New Jersey.

“We are seeing tremendous variation in cardiovascular disease burden across the nation, not only between states, but also between men and women,” said Dr. Ali Mokdad, Professor of Global Health at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The study, published today in JAMA Cardiology, covers 1990 to 2016; it is part of the Global Burden of Disease (GBD) study, a comprehensive effort to quantify health internationally. Researchers reviewed 10 causes, including rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, and atrial fibrillation, as well as other cardiovascular and circulatory diseases.

While the total number of CVD-related disability-adjusted life years (DALYs) increased in more than half of all states between 1990 and 2016, the age-standardized rate of CVD DALYs actually declined in all states over the same period, but with wide regional variation. Nationally, the CVD DALY rate fell by 38% between 1990 and 2016, with New York seeing the largest decline of 46% and Oklahoma the smallest at 22%.

In contrast, many developing countries saw greater declines, including Ireland, Portugal, Norway, Singapore, Israel, Denmark, and South Korea, each of which decreased by 60% or greater over the 26-year span.

In 2016, the highest CVD DALY rate was seen in Mississippi (4,982 DALYs per 100,000 people), with the lowest in Minnesota (2,352 DALYs per 100,000 people).

Despite declines in CVD DALY rates across all states from 1990 to 2016,researchers found increases in the total burden of CVD in 12 states over the past six years between 2010 and 2016.

“Our study findings indicate a possible reversal in the long-term decline of cardiovascular disease burden across many states, largely because of US population growth and aging,” said Mokdad.

Researchers found more than 80% of CVD burden in 2016 could be attributed to 10 modifiable risk factors: dietary risks, high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, low levels of physical activity, air pollution, impaired kidney function, and alcohol use.

However, after considering these, researchers concluded that exposure to other risks, such as health-care-related treatment, is driving the increase in CVD burden.  

“The US is seeing a much slower decline in health loss from cardiovascular diseases than other developing countries.” said Mokdad. “To catch up, the US should focus on preventable risks – especially behavior changes such as tobacco, alcohol, and diet – which can lead to a ‘domino effect’ in reducing health loss from other diseases such as diabetes and cancers.”

Additional key findings include:

  • The greatest CVD burden in 2016 was concentrated in a band of states starting at the Gulf of Mexico and extending north to West Virginia.
  • Ischemic heart disease was the leading cause of age-standardized CVD DALYs in all states and the District of Columbia in 2016.
  • For nearly all states, dietary risk factors were responsible for the greatest proportion of age-standardized CVD DALYs.
  • While total CVD DALYs were twice as large among men compared with women, age-standardized CVD DALY rates were lower for women across all states. However, the overall decline from 1990-2016 was slower for women than men in all states.

The study, “The burden of cardiovascular diseases among US states, 1990–2016,” was published today in JAMA Cardiology.

NOTE: The overarching GBD analysis on which this CVD study was based, entitled “The state of US health, 1990–2016,” was published in JAMA on April 10, 2018.


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About the Institute for Health Metrics and Evaluation
The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME makes this information widely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to improve population health.