Identifying the Causes of the Stagnation in National U.S. Cardiovascular Disease Mortality

查明美国全国心血管疾病死亡率停滞不前的原因

• 批准号: 10585800
• 负责人: NEIL MEHTA
• 金额: $ 38.81万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-15 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10585800
• 关键词: Accounting; Acute; Address; Affect; Alcohol consumption; American; Attention; Behavioral; Birth; COVID-19 pandemic; Cardiovascular Diseases; Cessation of life; Cholesterol; Complex; Data; Death Rate; Dependence; Diabetes Mellitus; Disease; Disparity; Economics; Elderly; Ethnic Origin; Event; Failure; Future; Geography; Growth; Health system; Heterogeneity; Hypertension; Individual; Joints; Life; Life Expectancy; Measures; Methods; Modeling; Mortality Decline; Myocardial Infarction; Obesity; Paper; Pattern; Pharmaceutical Preparations; Policies; Population; Population Heterogeneity; Prevalence; Process; Public Health; Publishing; Race; Recording of previous events; Research; Risk; Risk Factors; Role; Running; Smoking; Socioeconomic Status; Stroke; Subgroup; Suicide; Survival Rate; Survivors; Time; United States; United States National Academy of Sciences; Urbanicity; Work; age group; analytical tool; cardiovascular disorder risk; cardiovascular risk factor; cigarette smoking; cohort; experience; frailty; geographic disparity; high risk; hypercholesterolemia; improved; insight; intergenerational; lens; mortality; novel; novel strategies; overdose death; population health; simulation; social; socioeconomics; trend; young adult

PROJECT SUMMARY Since 2010, U.S. life expectancy improvements have stalled and in certain years declined. Much attention to this stall has focused on the role of rising drug overdose deaths. In published work, however, our team has identified stagnating declines in cardiovascular disease (CVD) mortality to be the major culprit. A failure to improve CVD mortality puts the U.S. at risk for sustained declines in inter-generational life expectancy. However, to date, research has not identified why U.S. CVD mortality is stagnating and, for some age groups, increasing. Using novel approaches, we will investigate four hypotheses for stagnating CVD mortality: (a) rising obesity and the resulting increase in CVD risk at a national level, (b) plateauing declines in cigarette smoking, (c) survivor effects attributable to improved survival among those with a history of a CVD event, and (d) rising levels of socio-economic vulnerability and geographic disparities. Aim 1 identifies the role that changes in obesity (Aim 1a) and cigarette smoking levels (Aim 1b) are having on national-level CVD mortality. We will reconstruct cohort histories of obesity to model the aggregate effects of both current and earlier-in-life obesity incorporating the dynamics of obesity duration in the population across time. We will provide the first estimates of the role of slowdowns in the decline in cigarette smoking use to CVD mortality trends by extending the Preston Glei Wilmoth approach to cause-specific mortality. We will also apply g-method approaches to identify the joint effects of obesity and smoking accounting for the dynamic relationship between the two variables. We will provide new estimates of the changing prevalence, treatment, and control of three other established CVD risk factors (diabetes, hypertension, high cholesterol) (Aim 1c). Aim 2 investigates “survival effects”, namely that improved survival among those with a history of stroke or a heart attack have accumulated in the population raising the overall frailty of the population. We will apply a novel simulation to quantify its role. Aim 3 turns the lens to disparities and provides an in-depth accounting of heterogeneity in recent CVD trends by geography, race, nativity and socioeconomic status. Examining subpopulation heterogeneity will reveal whether patterns of CVD mortality align with those of diseases of despair. We will apply the methods developed in Aims 1 and 2 to account for disparities in levels and trends in CVD mortality across population subgroups. We will also explicitly investigate the role of the shifting population composition of the United States with respect to nativity and race/ethnicity. The stagnation in U.S. CVD mortality declines has now been evident for a decade without a clear explanation. The COVID-19 pandemic may only worsen existing trends. Given the magnitude of the change in the CVD mortality trajectory and the fact that it is now affecting Americans of most age groups indicates that more than one causal factor is responsible. This project will be a comprehensive and rigorous treatment of leading explanations for the stagnation.

项目概要 自 2010 年以来，美国人的预期寿命增长停滞不前，在某些年份还大幅下降。 然而，在已发表的研究中，人们对这一问题的关注集中在药物过量死亡人数上升的作用上。 研究小组发现心血管疾病（CVD）死亡率的停滞下降是罪魁祸首。 未能改善心血管疾病死亡率将使美国面临代际寿命持续下降的风险 然而，迄今为止，研究尚未确定美国心血管疾病死亡率停滞不前的原因，以及对某些人来说 我们将使用新方法研究 CVD 停滞的四种假设。 死亡率：(a) 肥胖率上升以及由此导致的全国范围内心血管疾病风险的增加，(b) 死亡率下降趋于稳定 吸烟，(c) 幸存者效应可归因于有 CVD 病史的患者生存率的提高 事件，以及 (d) 社会经济脆弱性和地理差异程度不断上升。 目标 1 确定了肥胖（目标 1a）和吸烟水平（目标 1b）的变化对健康的影响。 我们将重建肥胖队列历史来模拟总体情况。 当前和早期肥胖的影响，结合了肥胖持续时间的动态 我们将提供对卷烟减少的影响的初步估计。 通过将 Preston Glei Wilmoth 方法扩展到特定原因，吸烟对 CVD 死亡率趋势的影响 我们还将应用 g 方法来确定肥胖和吸烟的联合影响。 我们将提供对两个变量之间的动态关系的新估计。 改变其他三个已确定的 CVD 危险因素（糖尿病、 高血压、高胆固醇）（目标 1c）研究“生存效应”，即提高生存率。 有中风或心脏病史的人在人口中的积累提高了总体 我们将应用一种新颖的模拟来量化其作用，目标 3 将镜头转向差异。 并对最近 CVD 趋势的异质性进行了深入分析，按地理、种族、出生地和 检查亚人群的异质性将揭示心血管疾病死亡率的模式。 我们将应用目标 1 和 2 中开发的方法来解释绝望疾病。 我们还将明确调查不同人群的 CVD 死亡率水平和趋势的差异。 美国人口结构变化在出生地和种族/族裔方面的作用。 美国心血管疾病死亡率下降十年来明显停滞不前，但没有明确的证据 鉴于变化的幅度，COVID-19 大流行可能只会恶化现有趋势。 CVD 死亡率轨迹以及它现在影响大多数年龄段的美国人的事实表明 造成原因不止一个，本项目将进行全面、严格的处理。 对停滞的主要解释。