GEOGRAPHIC PATTERNS OF CVD MORTALITY IN THE USA

Cardiovascular disease (CVD) is commonly analyzed in the epidemiologic literature as a single large category, as sub-categories such as hype rtension or myocardial infarction. This analysis groups CVD (Internati onal Classification of Diseases, 9th rec., Clinical Modification, 390- 459 and 745-747) mortality rates into three different groups: atherosc lerosis-related CVD (ACVD), hypertension-related CVD (HCVD), and all o ther CVD diagnoses (OCVD). Mortality data from the National Vital Stat istics Cooperative Program (National Center for Health Statistics) for the years 1960-1990 (by 10-year intervals) were placed into these thr ee groupings and age adjusted. These data were examined by gender and race for all 50 states and the District of Columbia and then mapped. T he patterns for ACVD, HCVD, and OCVD are different. The familiar clust ering of high mortality rates in the southeastern U.S.A. is present fo r HCVD, but not for the other two groups. HCVD, but not for the other groups. HCVD patterns for 1960-1990 are virtually unchanged, indicatin g no geographic shifting. For ACVD, the highest mortality rates cluste red in the northeast coastal states of the U.S.A. in 1960. The decline in mortality was not uniform. For 1990, the states with the highest r ates clustered along the Ohio trends indicate that the etiologic patte rns for HCVD and ACVD have varied in different HCVD and ACVD have vari ed in different parts of the United States. Ecological analyses and in tervention efforts should be targeted to the specific profiles and nee ds of these geographic areas.