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Trends in Ischemic Heart Disease Deaths -- United States, 1990-1994

In 1994, a total of 481,458 persons died as a result of ischemic heart disease (IHD), which comprises two thirds of all heart disease -- the leading cause of death in the United States. This report presents trends in IHD mortality in the United States for 1990-1994 (the latest year for which data are available) and compares these trends by race, sex, and state. These findings indicate IHD death rates decreased from 1990 through 1994; however, the rate of decline was slower than rates of previously observed declines.

Age-adjusted IHD death rates for persons aged greater than or equal to 35 years were calculated using mortality data tapes compiled by CDC and population estimates from the Bureau of the Census. IHD death rates were directly age-adjusted to the 1980 U.S. standard population aged greater than or equal to 35 years. IHD deaths were defined as those with the underlying cause of death listed on the death certificate as International Classification of Diseases, Ninth Revision {ICD-9}, codes 410-414.9. The average annual percentage change in IHD mortality from 1990 through 1994 was calculated as the 1994 rate minus the 1990 rate divided by the 1990 rate divided by 4 multiplied by 100. Data are presented only for blacks and whites because numbers for other racial/ethnic groups were too small for meaningful analysis.

From 1990 through 1994, age-adjusted IHD death rates for the U.S. population aged greater than or equal to 35 years decreased 10.3%, from 416.3 deaths per 100,000 to 373.6 deaths per 100,000. However, the rate of decrease varied by race and sex; rates of decline were faster for whites than for blacks and for men than for women (Figure_1). The largest average annual percentage decrease occurred among white men (2.9% per year), followed by white women (2.5%), black men (2.3%), and black women (1.6%).

IHD death rates varied substantially among the states (Table_1). In 1994, the rates for both women and men residing in the states with the highest IHD death rates were approximately two times higher than for persons residing in the states with the lowest IHD death rates. For women, IHD death rates in 1994 ranged from 156.7 per 100,000 (Montana) to 406.3 per 100,000 (New York) and, for men, ranged from 289.4 per 100,000 (New Mexico) to 638.8 per 100,000 (New York).

From 1990 through 1994, IHD death rates declined in nearly all 50 states and the District of Columbia (Table_1). However, the magnitude of change over time varied widely; some states had small declines (e.g., Nevada, 0.1% per year and Hawaii, 0.9% per year) while other states experienced larger declines (e.g., Alaska, 5.5% per year and Montana, 5.6% per year). Sex-specific IHD death rates for both men and women declined for each state except Idaho and Nevada (small increase for women only) and the District of Columbia (small increase for men only).

Reported by: Cardiovascular Health Br, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that, for persons aged greater than or equal to 35 years, age-adjusted IHD death rates decreased during 1990-1994; however, the magnitude of decline varied by race, sex, and state and was slower than the decline that occurred during the 1980s (1). During 1980-1988, IHD death rates declined an average of 3.0% per year, and during 1990-1994, declined an average of 2.6%. The slowing of the decline in IHD death rates was first observed in the mid-1970s for black women, black men, and white women (2). The initial declines in IHD death rates occurred during the 1960s, when rates declined steadily for each racial/sex group. The earliest declines in rates occurred in metropolitan areas, especially those located in the Northeast and Pacific West and in communities with higher levels of socioeconomic development (as reflected by occupational, educational, and income profiles of these communities) (3,4 ).

Factors contributing to the differential levels and rates of decline in IHD death rates by race, sex, and state may include differences in 1) trends in socioeconomic and behavioral risk factors for IHD, 2) access to quality health care, and 3) geographic and temporal variation in the medical certification of IHD. Previous reports indicate that IHD death rates vary inversely with social, economic, and medical resources (5,6). Higher levels of community resources contribute to declines in IHD death rates by providing or increasing opportunities for community members to have access to low-fat and high-fiber foods; engage in leisure-time physical activity; quit smoking; and receive medical care for treatment of other conditions and risk factors, including hypertension, hypercholesterolemia, and diabetes. For example, in 1988, the prevalence of leisure-time physical inactivity in 37 states correlated positively with IHD death rates (7), and in 1960, per capita cigarette sales in 44 states also correlated directly with IHD mortality (8). These findings indicate the potential for reducing state-specific IHD death rates through statewide promotion of public health policies and legislation that encourages and enables healthy living and working conditions.

Strategies for further reducing the substantial burden of IHD mortality in all states should include improving understanding of the socioeconomic, behavioral, and medical determinants of state variation in IHD death rates. The slowing of declines in IHD death rates underscores the need for innovative approaches to the prevention of IHD, and the intensification of current programs and policies that promote widespread accessibility and adoption of low-fat and high-fiber foods; incentives for smoking cessation; opportunities for leisure-time physical activity; and use of medical-care resources to prevent hypertension, diabetes, and hypercholesterolemia.

References

  1. CDC. Trends in ischemic heart disease mortality -- United States, 1980-1988. MMWR 1992;41:548-9,555-6.

  2. Sempos C, Cooper R, Kovar MG, McMillen M. Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States. Am J Public Health 1988;78:1422-7.

  3. Wing S, Casper M, Riggan W, Hayes C, Tyroler HA. Socioenvironmental characteristics associated with the onset of decline of ischemic heart disease mortality in the United States. Am J Public Health 1988;78:923-6.

  4. Wing S, Barnett E, Casper M, Tyroler HA. Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in white women. Am J Public Health 1992;82:204-9.

  5. Wing S, Dargent-Molina P, Casper M, Riggan W, Hayes C, Tyroler HA. Changing association between community occupational structure and ischaemic heart disease mortality in the United States. Lancet 1987;2:1067-70.

  6. Ingram DD, Gillum RF. Regional and urbanization differentials in coronary heart disease mortality in the United States, 1968-85. J Clin Epidemiol 1989;42:857-68.

  7. Yeager KK, Anda RF, Macera CA, Donehoo RS, Eaker ED. Sedentary lifestyle and state variation in coronary heart disease mortality. Public Health Rep 1995;110:100-2.

  8. Friedman GD. Cigarette smoking and geographic variation in coronary heart disease mortality in the United States. Journal of Chronic Diseases 1967;20:769-79.



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    Figure_1
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    Table_1
    Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
    
    
    
    
    
    
    
    TABLE 1. Age-adjusted death rate* for ischemic heart disease among adults aged >35 years, by year, and
    average annual percentage change in rate from 1990 to 1994, by gender and state -- United States
    ========================================================================================================
    
                             Women                    Men                      Total
                    ----------------------- ------------------------  -------------------------
                                  % Change                  % Change                  % Change
                                  from 1990                 from 1990                 from 1990
    State           1990    1994   to 1994    1990    1994   to 1994    1990    1994   to 1994
    --------------------------------------------------------------------------------------------------------
    Alabama         263.8   231.3   -3.1     510.1   448.3   -3.1     366.9   321.9   -3.1
    Alaska          197.6   189.3   -1.1     491.5   345.7   -7.4     338.3   263.9   -5.5
    Arizona         273.1   237.6   -3.2     504.1   428.5   -3.7     375.7   324.1   -3.4
    Arkansas        321.8   304.5   -1.3     592.5   567.7   -1.0     437.8   420.9   -1.0
    California      306.4   280.1   -2.1     505.9   456.7   -2.4     392.2   356.5   -2.3
    Colorado        246.3   189.6   -5.8     467.8   368.9   -5.3     341.6   266.2   -5.5
    Connecticut     262.0   235.1   -2.6     453.6   405.5   -2.7     341.9   306.9   -2.6
    Delaware        292.7   253.9   -3.3     493.5   463.2   -1.5     378.0   343.4   -2.3
    District
      of Columbia   199.2   177.8   -2.7     313.6   348.3    2.8     245.6   243.7   -0.2
    Florida         288.5   269.5   -1.6     528.7   477.7   -2.4     393.2   361.0   -2.0
    Georgia         289.4   254.0   -3.1     548.2   478.9   -3.2     395.0   346.1   -3.1
    Hawaii          189.1   173.9   -2.0     307.8   305.5   -0.2     244.6   235.8   -0.9
    Idaho           235.3   239.6    0.5     486.4   418.1   -3.5     346.3   320.4   -1.9
    Indiana         342.7   315.4   -2.0     581.0   538.0   -1.9     440.9   408.7   -1.8
    Illinois        338.4   305.9   -2.4     630.8   555.5   -3.0     459.1   410.2   -2.7
    Iowa            271.3   252.2   -1.8     535.9   491.4   -2.1     380.8   353.3   -1.8
    Kansas          270.2   234.0   -3.3     529.9   452.5   -3.7     378.6   326.6   -3.4
    Kentucky        326.4   300.5   -2.0     635.0   585.0   -2.0     455.3   420.0   -1.9
    Louisiana       341.2   276.5   -4.7     597.2   498.4   -4.1     449.3   369.0   -4.5
    Maine           294.9   268.0   -2.3     554.8   474.2   -3.6     404.2   356.7   -2.9
    Maryland        247.0   226.3   -2.1     430.8   393.0   -2.2     323.4   296.6   -2.1
    Massachusetts   282.4   243.6   -3.4     524.6   446.3   -3.7     381.9   327.8   -3.5
    Michigan        358.1   316.8   -2.9     612.8   527.2   -3.5     466.0   406.8   -3.2
    Minnesota       242.1   194.8   -4.9     518.9   423.8   -4.6     358.3   293.0   -4.6
    Mississippi     292.4   281.6   -0.9     557.1   510.7   -2.1     404.2   379.1   -1.6
    Missouri        339.4   327.7   -0.9     632.6   569.5   -2.5     460.2   428.9   -1.7
    Montana         215.5   156.7   -6.8     454.5   367.2   -4.8     321.3   249.9   -5.6
    Nebraska        244.1   208.9   -3.6     501.5   442.0   -3.0     351.2   307.3   -3.1
    Nevada          216.8   224.3    0.9     401.8   383.1   -1.2     299.8   299.0   -0.1
    New Hampshire   266.8   249.3   -1.6     529.5   461.6   -3.2     376.1   338.2   -2.5
    New Jersey      340.7   300.5   -2.9     576.7   514.5   -2.7     439.1   390.6   -2.8
    New Mexico      198.5   162.7   -4.5     331.3   289.4   -3.2     258.9   218.3   -3.9
    New York        425.0   406.3   -1.1     698.9   638.8   -2.1     537.2   502.0   -1.6
    North Carolina  307.1   274.0   -2.7     609.8   544.8   -2.7     431.7   385.4   -2.7
    North Dakota    235.9   229.4   -0.7     534.8   484.5   -2.4     367.1   340.2   -1.8
    Ohio            344.3   307.8   -2.7     629.7   553.8   -3.0     461.3   410.5   -2.8
    Oklahoma        337.6   307.8   -2.2     648.4   602.0   -1.8     468.1   434.0   -1.8
    Oregon          264.2   216.2   -4.5     529.9   425.8   -4.9     378.7   307.9   -4.7
    Pennsylvania    321.4   296.1   -2.0     577.8   506.9   -3.1     427.5   384.9   -2.5
    Rhode Island    323.9   288.4   -2.7     584.4   535.3   -2.1     426.9   391.1   -2.1
    South Carolina  315.2   288.3   -2.1     583.1   528.5   -2.3     427.6   388.4   -2.3
    South Dakota    283.7   243.3   -3.6     576.3   522.8   -2.3     409.7   366.8   -2.6
    Tennessee       326.0   310.6   -1.2     643.0   582.9   -2.3     456.7   422.2   -1.9
    Texas           289.8   270.2   -1.7     538.0   482.8   -2.6     394.8   361.0   -2.1
    Utah            201.2   175.7   -3.2     377.3   346.2   -2.1     277.6   251.5   -2.4
    Vermont         255.4   226.3   -2.8     483.9   468.9   -0.8     354.9   330.5   -1.7
    Virginia        275.4   236.9   -3.5     511.1   452.5   -2.9     373.9   326.7   -3.2
    Washington      234.6   199.3   -3.8     444.0   388.3   -3.1     325.3   282.7   -3.3
    West Virginia   337.8   307.8   -2.2     626.8   537.9   -3.5     458.0   404.7   -2.9
    Wisconsin       306.8   255.9   -4.1     579.0   499.5   -3.4     422.8   360.4   -3.7
    Wyoming         216.7   208.9   -0.9     495.5   435.4   -3.0     335.3   310.4   -1.9
    
    Total           311.7   281.8   -2.4     560.4   497.8   -2.8     416.3   373.6   -2.6
    --------------------------------------------------------------------------------------------------------
    * Per 100,000 population, adjusted to the 1980 U.S. standard population.
    + International Classification of Diseases, Ninth Revision, code 410-414.9.
    ========================================================================================================
    
    

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