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
Christopher J L MurrayMajid Ezzati

Abstract

Coronary heart disease (CHD) represents the largest share of cardiovascular disease in the United States, but there are conspicuous discrepancies between CHD and total cardiovascular death rates across the states, possibly due in part to variations in physician assignment of causes of death. Our aim was to identify exogenous individual- and community-level predictors of cause-of-death assignment and variability and to use these predictors to improve the comparability of CHD mortality estimates across states. We performed a multinomial logistic regression analysis to estimate the effect of individual- and community-level factors on the likelihood of a death being certified as 1 of 3 ill-defined clusters (general atherosclerosis and unspecified heart disease, heart failure, and cardiac arrest) relative to being certified as CHD. The individual-level variables were the decedent's race, sex, age, education, and place of death; the community-level variable was the number of cardiologists per capita. We used the model to estimate state-level CHD rates that are standardized with regard to the levels of individual- and community-level determinants of cause-of-death assignment. Decedents who died in hospitals and in counties with more c...Continue Reading

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Citations

Sep 15, 2011·European Journal of Clinical Nutrition·R MichaUNKNOWN Global Burden of Diseases, Nutrition and Chronic Disease Expert Group
Mar 6, 2012·BMJ : British Medical Journal·Joshua A SalomonEduardo González-Pier
Dec 14, 2011·American Journal of Physiology. Heart and Circulatory Physiology·Alice ChanakiraSabita Roy
Oct 20, 2006·Population Health Metrics·Catherine M MichaudChristopher J L Murray
Sep 29, 2009·Population Health Metrics·Goodarz DanaeiMajid Ezzati
Apr 15, 2010·Population Health Metrics·Gretchen A StevensKenji Shibuya
Nov 23, 2007·PLoS Medicine·Christopher J L MurrayGonghuan Yang
Aug 13, 2013·PloS One·Gitanjali M SinghUNKNOWN Prospective Studies Collaboration (PSC)
Apr 11, 2014·Population Health Metrics·Michelle L SnyderGerardo Heiss
Jun 17, 2015·Nature Reviews. Cardiology·Majid EzzatiDavid A Leon
Jan 6, 2015·Bulletin of the World Health Organization·Shefali OzaSimon N Cousens
Aug 2, 2008·Public Health Nutrition·Ffion Lloyd-WilliamsSimon Capewell
Jun 11, 2019·Circulation·Vasilis KontisGoodarz Danaei
Aug 26, 2020·European Journal of Preventive Cardiology·Paolo A CortesiUNKNOWN GBD 2017 Italy Cardiovascular Diseases Collaborators
May 10, 2021·European Journal of Preventive Cardiology·Paolo A CortesiUNKNOWN GBD 2017 Italy Cardiovascular Diseases Collaborators
May 21, 2021·PLoS Medicine·Andrew C StokesSamuel H Preston
Sep 30, 2021·Cardiovascular Diabetology·Jiyun ParkJae Hyeon Kim

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