In the United States, the number of people aged 65 years and older has increased from 41.4 million in 2011 to 50.9 million in 2017 and is projected to increase to 73.1 million by 2030. Likewise, the issue of diseases affecting those older than 65 years has become increasingly important to healthcare professionals. A recent report in JAMA Cardiology examined the association between population changes and patterns of heart disease mortality subtypes, with a focus on the increase in adults aged 65 years and older.
The researchers obtained data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) for the number of deaths, mortality rates, and US demographic data between 2000 and 2017. A population projection for 2030 was obtained from the US Census Bureau, and the standard population was identified with data from the 2000 US census.
Researchers determined that approximately 80% of deaths from heart disease were in adults aged 65 years and older despite a deceleration in the rate of decrease in mortality through 2017. This was associated with increased heart disease deaths across all subgroups. Coronary heart disease (CHD) mortality rates saw a 14.9% decrease from 2011 to 2017, and deaths from CHD decreased 2.5% for those years for men and nonwhite race/ethnicity groups. The rate of heart failure (HF) mortality when listed as an underlying cause of death increased substantially from 2011 to 2017, resulting in a 38.0% increase in deaths where HF was an underlying cause; this was consistent with patterns when HF was listed as a contributing cause of death. For age-adjusted rates of heart diseases, the mortality rate increased in men and all but those with Asian/Pacific Island ancestry, and the death rate increased across all subgroups from 2011 to 2017. When examining the rates of HF and CHD as underlying or contributing causes, the researchers found that nearly all deaths in patients with CHD and HF had CHD listed as an underlying cause.
Overall, the data showed that rates of mortality from HD slowed in decrease from 2011 to 2014 and continued the same trend through 2017. The study authors posit that this was a result of substantial increases in obesity and diabetes rates across the last few decades, as well as to the increasing number of adults aged 65 years and older. The finding that HF-associated mortality rates are increasing is consistent with prior studies.
Limitations of the report included possible misclassification of death certificate because of the lack of access to clinical information for patients. In addition, there could be potential miscoding of HF in cardiac arrest or ventricular flutter or fibrillation. Other factors that could increase HF mortality, such as social factors for at-risk groups, types of HF, adherence to medical treatment, and so on, could also have an effect; however, these factors were not available in the national data used in the study.
Although there was a decrease in age-adjusted mortality from HD and CHD, death rates associated with HF and other forms of HD have increased in recent years. As the population of those aged 65 years and older grows, the number of HD deaths will likely increase in conjunction. Because of this, new ways of treating and managing various types of heart disease are urgently needed.
Sidney S, Go AS, Jaffe MG, Solomon MD, Ambrosy AP, Rana JS. Association between aging of the US population and heart disease mortality from 2011 to 2017 [published online October 30, 2019]. JAMA Cardiol. doi:10.1001/jamacardio.2019.4187.