The burden of cardiovascular diseases among us states, 1990-2016
IMPORTANCE Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously. OBJECTIVE To quantify and descr...
- Autores:
-
Roth, Gregory A.
Johnson, Catherine O.
Abate, Kalkidan Hassen
Abd-Allah, Foad
Ahmed, Muktar
Alam, Khurshid
Alam, Tahiya
Alvis-Guzman, Nelson
Ansari, Hossein
Ärnlöv, Johan
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2018
- Institución:
- Corporación Universidad de la Costa
- Repositorio:
- REDICUC - Repositorio CUC
- Idioma:
- eng
- OAI Identifier:
- oai:repositorio.cuc.edu.co:11323/4770
- Acceso en línea:
- https://hdl.handle.net/11323/4770
https://repositorio.cuc.edu.co/
- Palabra clave:
- La enfermedad cardiovascular
Causa de muerte
Estados Unidos
Cardiovascular disease
Cause of death
U.S
- Rights
- openAccess
- License
- Attribution-NonCommercial-ShareAlike 4.0 International
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dc.title.spa.fl_str_mv |
The burden of cardiovascular diseases among us states, 1990-2016 |
dc.title.translated.spa.fl_str_mv |
La carga de las enfermedades cardiovasculares entre nosotros estados, 1990-2016 |
title |
The burden of cardiovascular diseases among us states, 1990-2016 |
spellingShingle |
The burden of cardiovascular diseases among us states, 1990-2016 La enfermedad cardiovascular Causa de muerte Estados Unidos Cardiovascular disease Cause of death U.S |
title_short |
The burden of cardiovascular diseases among us states, 1990-2016 |
title_full |
The burden of cardiovascular diseases among us states, 1990-2016 |
title_fullStr |
The burden of cardiovascular diseases among us states, 1990-2016 |
title_full_unstemmed |
The burden of cardiovascular diseases among us states, 1990-2016 |
title_sort |
The burden of cardiovascular diseases among us states, 1990-2016 |
dc.creator.fl_str_mv |
Roth, Gregory A. Johnson, Catherine O. Abate, Kalkidan Hassen Abd-Allah, Foad Ahmed, Muktar Alam, Khurshid Alam, Tahiya Alvis-Guzman, Nelson Ansari, Hossein Ärnlöv, Johan |
dc.contributor.author.spa.fl_str_mv |
Roth, Gregory A. Johnson, Catherine O. Abate, Kalkidan Hassen Abd-Allah, Foad Ahmed, Muktar Alam, Khurshid Alam, Tahiya Alvis-Guzman, Nelson Ansari, Hossein Ärnlöv, Johan |
dc.subject.spa.fl_str_mv |
La enfermedad cardiovascular Causa de muerte Estados Unidos Cardiovascular disease Cause of death U.S |
topic |
La enfermedad cardiovascular Causa de muerte Estados Unidos Cardiovascular disease Cause of death U.S |
description |
IMPORTANCE Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously. OBJECTIVE To quantify and describe levels and trends of lost health due to CVD within the United States from 1990 to 2016 as well as risk factors driving these changes. DESIGN, SETTING, AND PARTICIPANTS Using the Global Burden of Disease methodology, cardiovascular disease mortality, nonfatal health outcomes, and associated risk factors were analyzed by age group, sex, and year from 1990 to 2016 for all residents in the United States using standardized approaches for data processing and statistical modeling. Burden of disease was estimated for 10 groupings of CVD, and comparative risk analysis was performed. Data were analyzed from August 2016 to July 2017. |
publishDate |
2018 |
dc.date.issued.none.fl_str_mv |
2018 |
dc.date.accessioned.none.fl_str_mv |
2019-06-04T13:19:26Z |
dc.date.available.none.fl_str_mv |
2019-06-04T13:19:26Z |
dc.type.spa.fl_str_mv |
Artículo de revista |
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http://purl.org/coar/resource_type/c_2df8fbb1 |
dc.type.coar.spa.fl_str_mv |
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http://purl.org/redcol/resource_type/ART |
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acceptedVersion |
dc.identifier.uri.spa.fl_str_mv |
https://hdl.handle.net/11323/4770 |
dc.identifier.instname.spa.fl_str_mv |
Corporación Universidad de la Costa |
dc.identifier.reponame.spa.fl_str_mv |
REDICUC - Repositorio CUC |
dc.identifier.repourl.spa.fl_str_mv |
https://repositorio.cuc.edu.co/ |
url |
https://hdl.handle.net/11323/4770 https://repositorio.cuc.edu.co/ |
identifier_str_mv |
Corporación Universidad de la Costa REDICUC - Repositorio CUC |
dc.language.iso.none.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.spa.fl_str_mv |
doi:10.1001/jamacardio.2018.0385 |
dc.relation.references.spa.fl_str_mv |
1. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151-1210. 2. Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad SciUSA. 2015;112 (49):15078-15083. 3. Sidney S, Quesenberry CP Jr, Jaffe MG, et al. Recent trends in cardiovascular mortality in the United States and public health goals.JAMA Cardiol. 2016;1(5):594-599. 4. O’Flaherty M, Buchan I, Capewell S. Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s? Heart. 2013;99 (3):159-162. 5. Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in US deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356(23):2388-2398. 6. Wang H, Schumacher AE, Levitz CE, Mokdad AH, Murray CJ. Left behind: widening disparities for males and females in US county life expectancy, 1985-2010. Popul Health Metr. 2013;11(1):8. 7. Ezzati M, Friedman AB, Kulkarni SC, Murray CJL. The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States. PLoS Med. 2008;5(4):e66. 8. Danaei G, Rimm EB, Oza S, Kulkarni SC, Murray CJ, Ezzati M. The promise of prevention: the effects of four preventable risk factors on national life expectancy and life expectancy disparities by race and county in the United States. PLoS Med. 2010;7 (3):e1000248. 9. Kaufman HW, Blatt AJ, Huang X, Odeh MA, Superko HR. Blood cholesterol trends 2001-2011 in the United States: analysis of 105 million patient records. PLoS One. 2013;8(5):e63416. 10. Ford ES, Capewell S. Trends in total and low-density lipoprotein cholesterol among US adults: contributions of changes in dietary fat intake and use of cholesterol-lowering medications. PLoS One. 2013;8(5):e65228. 11. Chen J, Normand S-LT, Wang Y, Krumholz HM. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998-2008.JAMA. 2011;306(15): 1669-1678. 12. Nichol G, Thomas E, Callaway CW, et al; Resuscitation Outcomes Consortium Investigators. Regional variation in out-of-hospital cardiac arrest incidence and outcome.JAMA. 2008;300(12): 1423-1431. 13. Roth GA, Poole JE, Zaha R, Zhou W, Skinner J, Morden NE. Use of guideline-directed medications for heart failure before cardioverter-defibrillator implantation.J Am Coll Cardiol. 2016;67(9):1062- 1069. 14. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390(10100):1211-1259. 15. GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100): 1345-1422. 16. GBD 2016 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1260-1344. 17. Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015.J Am Coll Cardiol. 2017;70(1):1-25. 18. United States Census Bureau. United States Population and Housing Census 2010. https://www.census.gov/prod/www/decennial .html. Accessed September 25, 2017. 19. Truven Health Analytics. United States MarketScan Commercial Claims and Encounters Database 2000. Ann Arbor, MI: Truven Health Analytics; 2000. 20. Salomon JA, Vos T, Hogan DR, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2129-2143. 21. Haagsma JA, Maertens de Noordhout C, Polinder S, et al. Assessing disability weights based on the responses of 30,660 people from four European countries. Popul Health Metr. 2015;13:10. 22. Record NB, Onion DK, Prior RE, et al. Community-wide cardiovascular disease prevention programs and health outcomes in a rural county, 1970-2010.JAMA. 2015;313(2):147-155. 23. Henry J Kaiser Family Foundation. Status of state action on the Medicaid expansion decision. https://www.kff.org/health-reform/state-indicator /state-activity-around-expanding-medicaid-under -the-affordable-care-act. Accessed September 25, 2017. 24. Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005;352 (11):1138-1145. 25. Starfield B. Pathways of influence on equity in health. Soc Sci Med. 2007;64(7):1355-1362. 26. Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, et al. US county-level trends in mortality rates for major causes of death, 1980-2014.JAMA. 2016;316 (22):2385-2401. 27. Ezzati M, Horwitz ME, Thomas DS, et al. Altitude, life expectancy and mortality from ischaemic heart disease, stroke, COPD and cancers: national population-based analysis of US counties. J Epidemiol Community Health. 2012;66(7):e17. 28. Mensah GA, Dunbar SB. A framework for addressing disparities in cardiovascular health. J Cardiovasc Nurs. 2006;21(6):451-456. 29. Skinner J, Chandra A, Staiger D, Lee J, McClellan M. Mortality after acute myocardial infarction in hospitals that disproportionately treat black patients. Circulation. 2005;112(17):2634-2641. 30. Howard G. Why do we have a stroke belt in the southeastern United States? a review of unlikely and uninvestigated potential causes. Am J Med Sci. 1999;317(3):160-167. 31. Oates GR, Jackson BE, Partridge EE, Singh KP, Fouad MN, Bae S. Sociodemographic patterns of chronic disease: how the Mid-South region compares to the rest of the country. Am J Prev Med. 2017;52(1S1):S31-S39. 32. Howard BV, Lee ET, Cowan LD, et al. Rising tide of cardiovascular disease in American Indians: the Strong Heart Study. Circulation. 1999;99(18):2389- 2395. 33. Mersha TB, Abebe T. Self-reported race/ethnicity in the age of genomic research: its potential impact on understanding health disparities. Hum Genomics. 2015;9:1. 34. Rana JS, Liu JY, Moffet HH, Jaffe MG, Sidney S, Karter AJ. Ethnic differences in risk of coronary heart disease in a large contemporary population. Am J Prev Med. 2016;50(5):637-641. 35. Lloyd-Jones DM, Hong Y, Labarthe D, et al; American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121(4):586-613. 36. Wright JT Jr, Williamson JD, Whelton PK, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103-2116. 37. LaRosa JC, Grundy SM, Waters DD, et al; Treating to New Targets (TNT) Investigators. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005; 352(14):1425-1435. 38. Stone NJ, Robinson JG, Lichtenstein AH, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25, suppl 2):S1-S45. 39. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published online November 13, 2017]. Hypertension. doi:10.1161/HYP .0000000000000066 40. Frieden TR, Berwick DM. The “Million Hearts” initiative: preventing heart attacks and strokes. N Engl J Med. 2011;365(13):e27. 41. Pope CAI III, Ezzati M, Dockery DW. Fine-particulate air pollution and life expectancy in the United States. N Engl J Med. 2009;360(4):376- 386. 42. Murray CJ, Kulkarni SC, Ezzati M. Understanding the coronary heart disease versus total cardiovascular mortality paradox: a method to enhance the comparability of cardiovascular death statistics in the United States. Circulation. 2006;113 (17):2071-2081. 43. Pearson-Stuttard J, Guzman-Castillo M, Penalvo JL, et al. Modeling future cardiovascular disease mortality in the United States: national trends and racial and ethnic disparities. Circulation. 2016;133(10):967-978. 44. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903-1913. 45. Bern C, Montgomery SP. An estimate of the burden of Chagas disease in the United States. Clin Infect Dis. 2009;49(5):e52-e54. 46. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053): 1545-1602. |
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Roth, Gregory A.Johnson, Catherine O.Abate, Kalkidan HassenAbd-Allah, FoadAhmed, MuktarAlam, KhurshidAlam, TahiyaAlvis-Guzman, NelsonAnsari, HosseinÄrnlöv, Johan2019-06-04T13:19:26Z2019-06-04T13:19:26Z2018https://hdl.handle.net/11323/4770Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/IMPORTANCE Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously. OBJECTIVE To quantify and describe levels and trends of lost health due to CVD within the United States from 1990 to 2016 as well as risk factors driving these changes. DESIGN, SETTING, AND PARTICIPANTS Using the Global Burden of Disease methodology, cardiovascular disease mortality, nonfatal health outcomes, and associated risk factors were analyzed by age group, sex, and year from 1990 to 2016 for all residents in the United States using standardized approaches for data processing and statistical modeling. Burden of disease was estimated for 10 groupings of CVD, and comparative risk analysis was performed. Data were analyzed from August 2016 to July 2017.IMPORTANCIA La enfermedad cardiovascular (ECV) es la principal causa de muerte en los Estados Unidos, pero la variación regional dentro de los Estados Unidos es grande. Nivel de estado comparable y consistente las medidas de la carga total de la ECV y los factores de riesgo no se han producido anteriormente. OBJETIVO Cuantificar y describir los niveles y tendencias de pérdida de salud debidos a ECV dentro de la Estados Unidos desde 1990 hasta 2016, así como los factores de riesgo que impulsan estos cambios. DISEÑO, AJUSTE Y PARTICIPANTES Usando la metodología de la Carga Global de la Enfermedad, La mortalidad por enfermedad cardiovascular, los resultados de salud no fatales y los factores de riesgo asociados fueron analizado por grupo de edad, sexo y año de 1990 a 2016 para todos los residentes en los Estados Unidos utilizando enfoques estandarizados para el procesamiento de datos y modelos estadísticos. Carga de la enfermedad se estimó para 10 agrupaciones de ECV y se realizó un análisis de riesgo comparativo. Los datos fueron analizados desde agosto de 2016 hasta julio de 2017.Roth, Gregory A.-61371630-7c04-4023-8775-8c7b4f280125-0Johnson, Catherine O.-4bbf8e6d-7b35-49a2-8418-65c409d62d8c-0Abate, Kalkidan Hassen-7f68f0b5-357f-4a33-89cb-cc36d3b43b75-0Abd-Allah, Foad-a9af1a20-8108-4516-9f91-d10165af1f4b-0Ahmed, Muktar-ccbdd2b7-b485-4d17-aa14-50ed928fa1a5-0Alam, Khurshid-4cb4de56-d656-48f8-97ba-6785d02e127d-0Alam, Tahiya-77c46441-8a47-4a50-82f2-e88a2b140093-0Alvis-Guzman, Nelson-8bd90d52-51ab-4917-ad57-b2424f106eac-0Ansari, Hossein-da1a5e17-47db-4f51-af50-6ba7b08ee09b-0Ärnlöv, Johan-f6f4a044-3022-4374-8974-b967781fdd1c-0engJAMA Networkdoi:10.1001/jamacardio.2018.03851. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151-1210. 2. Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad SciUSA. 2015;112 (49):15078-15083. 3. Sidney S, Quesenberry CP Jr, Jaffe MG, et al. Recent trends in cardiovascular mortality in the United States and public health goals.JAMA Cardiol. 2016;1(5):594-599. 4. O’Flaherty M, Buchan I, Capewell S. Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s? Heart. 2013;99 (3):159-162. 5. Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in US deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356(23):2388-2398. 6. Wang H, Schumacher AE, Levitz CE, Mokdad AH, Murray CJ. Left behind: widening disparities for males and females in US county life expectancy, 1985-2010. Popul Health Metr. 2013;11(1):8. 7. Ezzati M, Friedman AB, Kulkarni SC, Murray CJL. The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States. PLoS Med. 2008;5(4):e66. 8. Danaei G, Rimm EB, Oza S, Kulkarni SC, Murray CJ, Ezzati M. The promise of prevention: the effects of four preventable risk factors on national life expectancy and life expectancy disparities by race and county in the United States. PLoS Med. 2010;7 (3):e1000248. 9. Kaufman HW, Blatt AJ, Huang X, Odeh MA, Superko HR. Blood cholesterol trends 2001-2011 in the United States: analysis of 105 million patient records. PLoS One. 2013;8(5):e63416. 10. Ford ES, Capewell S. Trends in total and low-density lipoprotein cholesterol among US adults: contributions of changes in dietary fat intake and use of cholesterol-lowering medications. PLoS One. 2013;8(5):e65228. 11. Chen J, Normand S-LT, Wang Y, Krumholz HM. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998-2008.JAMA. 2011;306(15): 1669-1678. 12. Nichol G, Thomas E, Callaway CW, et al; Resuscitation Outcomes Consortium Investigators. Regional variation in out-of-hospital cardiac arrest incidence and outcome.JAMA. 2008;300(12): 1423-1431. 13. Roth GA, Poole JE, Zaha R, Zhou W, Skinner J, Morden NE. Use of guideline-directed medications for heart failure before cardioverter-defibrillator implantation.J Am Coll Cardiol. 2016;67(9):1062- 1069. 14. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390(10100):1211-1259. 15. GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100): 1345-1422. 16. GBD 2016 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1260-1344. 17. Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015.J Am Coll Cardiol. 2017;70(1):1-25. 18. United States Census Bureau. United States Population and Housing Census 2010. https://www.census.gov/prod/www/decennial .html. Accessed September 25, 2017. 19. Truven Health Analytics. United States MarketScan Commercial Claims and Encounters Database 2000. Ann Arbor, MI: Truven Health Analytics; 2000. 20. Salomon JA, Vos T, Hogan DR, et al. Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2129-2143. 21. Haagsma JA, Maertens de Noordhout C, Polinder S, et al. Assessing disability weights based on the responses of 30,660 people from four European countries. Popul Health Metr. 2015;13:10. 22. Record NB, Onion DK, Prior RE, et al. Community-wide cardiovascular disease prevention programs and health outcomes in a rural county, 1970-2010.JAMA. 2015;313(2):147-155. 23. Henry J Kaiser Family Foundation. Status of state action on the Medicaid expansion decision. https://www.kff.org/health-reform/state-indicator /state-activity-around-expanding-medicaid-under -the-affordable-care-act. Accessed September 25, 2017. 24. Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005;352 (11):1138-1145. 25. Starfield B. Pathways of influence on equity in health. Soc Sci Med. 2007;64(7):1355-1362. 26. Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, et al. US county-level trends in mortality rates for major causes of death, 1980-2014.JAMA. 2016;316 (22):2385-2401. 27. Ezzati M, Horwitz ME, Thomas DS, et al. Altitude, life expectancy and mortality from ischaemic heart disease, stroke, COPD and cancers: national population-based analysis of US counties. J Epidemiol Community Health. 2012;66(7):e17. 28. Mensah GA, Dunbar SB. A framework for addressing disparities in cardiovascular health. J Cardiovasc Nurs. 2006;21(6):451-456. 29. Skinner J, Chandra A, Staiger D, Lee J, McClellan M. Mortality after acute myocardial infarction in hospitals that disproportionately treat black patients. Circulation. 2005;112(17):2634-2641. 30. Howard G. Why do we have a stroke belt in the southeastern United States? a review of unlikely and uninvestigated potential causes. Am J Med Sci. 1999;317(3):160-167. 31. Oates GR, Jackson BE, Partridge EE, Singh KP, Fouad MN, Bae S. Sociodemographic patterns of chronic disease: how the Mid-South region compares to the rest of the country. Am J Prev Med. 2017;52(1S1):S31-S39. 32. Howard BV, Lee ET, Cowan LD, et al. Rising tide of cardiovascular disease in American Indians: the Strong Heart Study. Circulation. 1999;99(18):2389- 2395. 33. Mersha TB, Abebe T. Self-reported race/ethnicity in the age of genomic research: its potential impact on understanding health disparities. Hum Genomics. 2015;9:1. 34. Rana JS, Liu JY, Moffet HH, Jaffe MG, Sidney S, Karter AJ. Ethnic differences in risk of coronary heart disease in a large contemporary population. Am J Prev Med. 2016;50(5):637-641. 35. 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