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Coronary Heart Disease and Stroke Deaths --- United States, 2006

Nora L. Keenan, PhD

Kate M. Shaw, MS

National Center for Chronic Disease Prevention and Health Promotion, CDC

Corresponding author: Nora L. Keenan PhD, Division for Heart Disease and Stroke Prevention, 2877 Brandywine Road, MS K-47, Atlanta, GA 30341. Telephone: 770-488-6487; Fax: 770-488-8334; E-mail: nlk0@cdc.gov.

Heart disease and stroke are the first and third leading causes of death in the United States* (1) and have maintained this ranking since 1921 and 1938, respectively (2). In 2006, cardiovascular disease was responsible for 31.7% of all deaths: 26.0% from heart disease and 5.7% from stroke (1). Deaths from coronary heart disease (CHD) (425,425 deaths) comprise 67.4% of all deaths from heart disease (631,636 deaths). The Healthy People 2010 objectives of reducing death rates to 162 deaths per 100,000 population for CHD and 50 deaths per 100,000 for stroke (objectives 12-1 and 12-7) were met in 2004 (3). However, despite the overall decrease in CHD and stroke death rates, the target death rates for both diseases were not met for two subpopulations: blacks and men.

Healthy People 2020 has four overarching goals: 1) eliminate preventable disease, disability, injury, and premature death; 2) achieve health equity, eliminate disparities, and improve the health of all groups; 3) create social and physical environments that promote good health for all; and 4) promote healthy development and healthy behaviors across every life stage (4). Examining and monitoring the distribution of death rates provides the requisite information for focusing on the groups most in need of early intervention to eliminate preventable disease, disability, and premature death and to improve the health of all groups.

To examine CHD and stroke death rates among different segments of the U.S. population, CDC analyzed 2006 data from the National Vital Statistics System (NVSS). NVSS is maintained by CDC and compiles data from vital records on all deaths occurring annually in the United States (5). The 2006 CDC Wonder compressed mortality NVSS database (6) was used to obtain the number of deaths for which CHD or stroke was the underlying cause, population estimates for calculation of rates, and mortality rates per 100,000, age-standardized to the 2000 U.S. standard population (7). The underlying cause of death is the disease that initiated the sequence of events leading directly to death. Age-specific rate calculations were restricted to adults aged ≥45 years because 98.1% of CHD deaths and 97.6% of stroke deaths occurred among persons in this age group. CHD and stroke deaths were classified according to codes from the International Classification of Diseases, Tenth Revision (ICD-10) (8). The category of CHD (ICD-10 codes I20--I25) includes acute myocardial infarction, angina pectoris, atherosclerotic cardiovascular disease, and all other forms of acute and chronic ischemic heart disease. Stroke (ICD-10 codes I60--I69) includes ischemic and hemorrhagic strokes, strokes not specified as ischemic or hemorrhagic, and other cerebrovascular diseases (e.g., occlusion and stenosis of cerebral arteries) not resulting in cerebral infarction. Substantial differences in rates were determined by nonoverlapping confidence intervals (CIs), and these differences are discussed in the report; however, nonoverlapping CIs were not used as an indicator of statistical significance.

Trends in mortality disparities for CHD and stroke over time were not examined. In addition, death rates by educational attainment were not included because education information on the death certificates is unreliable, particularly for certain demographic groups (blacks, Hispanics, and Asians/Pacific Islanders [A/PIs]) (9).

In 2006, CHD was the underlying cause of death for 425,425 persons (all ages) in the United States; the age-adjusted mortality rate was 135.0 deaths per 100,000 standard population (Table 1). The rate for males was 41.6% higher than for females (176.5 versus 103.1 per 100,000 population, respectively). Blacks had higher age-adjusted rates than the other three racial/ethnic groups, and whites had higher rates than American Indians/Alaska Natives (AI/ANs) and A/PIs (Table 1).

In 2006, stroke was the underlying cause of death for 137,119 persons; the age-adjusted mortality rate was 43.6 per 100,000 standard population (Table 1). Rates for blacks were 32.3% higher than rates for whites (61.6 versus 41.7 per 100,000 population, respectively). Hispanics had lower death rates for both CHD and stroke than non-Hispanics.

The age-specific CHD mortality rates by sex, race/ethnicity, and age group highlight how the overall age-adjusted rate masks the differences in higher premature death rates (death before age 75 years) within the groups (Table 2). Among adults aged ≥45 years, a comparison of rates by race for the youngest age groups reveals that black women and men aged 45--74 years had much higher CHD death rates than women and men of the three other races. The proportion of CHD deaths that occurred among persons aged 45--74 years was higher for black women (37.9%) than white women (19.4%) and higher for black men (61.5%) than white men (41.5%). Non-Hispanic men and women aged 45--74 years had higher CHD death rates than their Hispanic counterparts (Table 3).

The pattern in premature death rates also is demonstrated in age-specific deaths caused by stroke (Table 4). Approximately 39% of black women who died of stroke died before age 75 years, compared with 17.3% of white women; 60.7% of black men who died of stroke died before age 75 years, compared with 31.1% of white men. Age-specific stroke death rates were similar for Hispanics and non-Hispanics (Table 5).

CHD and stroke age-adjusted mortality rates were also examined by state (Table 6). The range for CHD was from 77.5 deaths per 100,000 population (Utah) to 193.5 per 100,000 (District of Columbia), with a median of 126.1 per 100,000 (North Carolina). Rates for the majority of the southern states were higher than the median, whereas all but one western state (California) had rates lower than the median. Stroke mortality rates ranged from 29.7 deaths per 100,000 population (New York) to 58.8 per 100,000 (Arkansas). The median stroke rate was 44.3 per 100,000 population (Wisconsin). As with CHD, stroke rates for the majority of southern states were higher than the median; however, all the northeastern states had stroke rates lower than the median. A comparison of CHD and stroke rates among the states demonstrated that high CHD mortality rates did not necessarily correspond with high stroke rates. Although New York and Rhode Island had the second and fifth highest CHD rates, respectively (New York, 181.2 deaths per 100,000 population; Rhode Island, 162.4 per 100,000), these states had the lowest stroke rates (New York, 29.7 per 100,000 population; Rhode Island, 31.4 per 100,000). However, certain southern states with high CHD rates also had high stroke rates (Arkansas, Oklahoma, and Tennessee).

The findings in this report are subject to at least four limitations. First, misclassification of race and ethnicity of the decedent on the death certificate might underestimate rates among AI/ANs, A/PIs, and Hispanics (10). Second, results from a study in New York City, New York, indicated that CHD is overreported as a cause of death on death certificates (11). However, these results might be specific to New York City. Third, the death rates reflect only the underlying cause of death and not other contributing causes of death such as diabetes, which varies substantially across racial/ethnic groups. Finally, state of residence at death from CHD and stroke --- diseases that often have long latency periods --- might not reflect the location of the decedent's lifetime health, access to health care, and state cardiovascular health promotion activities.

The proposed Healthy People 2020 objectives for heart disease and stroke were developed to prevent premature death from cardiovascular disease by maintaining low risk for disease, controlling increased risk, detecting and treating heart attacks and strokes, and reducing disability and recurrence (12). Research examining health disparities in heart disease and stroke among persons who already have heart disease or have experienced a stroke often focuses on differences in access to care (13--16), use of diagnostic and surgical procedures (17--20), and type of medication used in treatment (21,22). Research examining the promotion of cardiovascular health through preventing onset of hypertension and atherosclerosis should be given priority because major disparities exist in the prevalence of cardiovascular risk factors among population groups at early ages (23--25). However, insufficient research has been conducted regarding behaviors that maintain low risk and prevent the initiation and progression of hypertension and atherosclerosis. Although there are no community guides for cardiovascular disease as a whole or heart disease, stroke, hypertension, or cholesterol in particular, the Guide to Community Preventive Services topic areas include diabetes, nutrition, physical activity, tobacco, and obesity (26). Promoting community guidelines for interventions based on systematic reviews of interventions in each of these topic areas will improve cardiovascular health and reduce deaths from heart disease and stroke. In addition to related community guides, the national clinical guidelines for cholesterol, hypertension and obesity are being updated and are expected to be released in fall 2011 (27).

References

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  2. CDC. National Center for Health Statistics. Leading causes of death 1900--1998. Available at http://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf.
  3. CDC. Healthy people data 2010: the healthy people database. Atlanta, GA: US Department of Health and Human Services, CDC; 2010. Available at http://wonder.cdc.gov/data2010.
  4. US Department of Health and Human Services. Healthy people 2020. Phase I report: recommendations for the framework and format of Healthy People 2020. Section IV. Advisory committee findings and recommendations: the role and function of Healthy People 2020. Rockville, MD: US Department of Health and Human Services; 2010. Available at http://www.healthypeople.gov/hp2020/advisory/PhaseI.
  5. CDC. National Vital Statistics System. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2010. Available at http://www.cdc.gov/nchs/nvss.htm.
  6. CDC. Compressed mortality file, 1999--2006. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2010. Available at http://wonder.cdc.gov/cmf-icd10.html.
  7. Anderson RN, Rosenberg HM. Age standardization of death rates: implementation of year 2000 standard. Natl Vital Stat Rep 1998;47(3):1--16, 20.
  8. World Health Organization (WHO). International statistical classification of diseases and related health problems. 10th Rev. 2nd ed. Geneva, Switzerland: WHO; 2007. Available at http://apps.who.int/classifications/apps/icd/icd10online/.
  9. Rostron BL, Bones JL, Arias E. Education reporting and classification on death certificates in the United States. National Center for Health Statistics. Vital Health Stat 2(151), 2010.
  10. Arias E, Schauman WS, Eschbach K, Sorlie PD, Backlund E. The validity of race and Hispanic origin reporting on death certificates in the United States. National Center for Health Statistics. Vital Health Stat 2(148); 2008.
  11. Agarwal R, Norton JM, Konty K, et al. Overreporting of deaths from coronary heart disease in New York City hospitals, 2003. Prev Chronic Dis 2010;7(3). Available at http://www.cdc.gov/pcd/issues/2010/may/09_0086.htm.
  12. US Department of Health and Human Services. Proposed healthy people objectives; focus areas: heart disease and stroke. Rockville, MD: US Department of Health and Human Services; 2010. Available at http://www.healthypeople.gov/hp2020/Objectives/TopicArea.aspx?id=28&TopicArea=Heart+Disease+and+Stroke.
  13. Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care 2002;40:52--9.
  14. Cook NL, Ayanian JZ, Orav EJ, Hicks LS. Differences in specialist consultations for cardiovascular disease by race, ethnicity, gender, insurance status, and site of primary care. Circulation 2009;119:2463--70.
  15. Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: confronting racial and ethnic disparities in health care. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Institute of Medicine. Washington, DC: National Academies Press; 2003.
  16. Agency for Healthcare Research and Quality. 2009 national healthcare disparities report. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2010. AHRQ publication no.10-0004. Available at http://www.ahrq.gov/qual/nhdr09/nhdr09.pdf.
  17. Bao Y, Kamble S. Geographical distribution of surgical capabilities and disparities in the use of high-volume providers: the case of coronary artery bypass graft. Med Care 2009;47:794--802.
  18. Casale SN, Auster CJ, Wolf F, Pei Y, Devereux RB. Ethnicity and socioeconomic status influence use of primary angioplasty in patients presenting with acute myocardial infarction. Am Heart J 2007;154;989--93.
  19. Halm EA, Tuhrim S, Wang JJ, et al. Racial and ethnic disparities in outcomes and appropriateness of carotid endarterectomy: impact of patient and provider factors. Stroke 2009;40:2493--501.
  20. Weitzman S, Cooper L, Chambless L, et.al. Gender, racial, and geographic differences in performance of cardiac diagnostic and therapeutic procedures for hospitalized acute myocardial infarction in four states. Am J Cardiol 1997;79:722--6.
  21. Qato DM, Lindau ST, Conti RM, Schumm LP, Alexander GC. Racial and ethnic disparities in cardiovascular medication use among older adults in the United States. Pharmacoepidemiol Drug Saf 2010;19:834--42.
  22. Keyhani S, Scobie JV, Herbert PL, McLaughlin MA. Gender disparities in blood pressure control and cardiovascular care in a national sample of ambulatory care visits. Hypertension 2008;51:1149--55.
  23. CDC. Racial/ethnic and socioeconomic disparities in multiple risk factors for heart disease and stroke---United States, 2003. MMWR 2005;54:113--7.
  24. Karlamangla AS, Merkin SS, Crimmins EM, Seeman TE. Socioeconomic and ethnic disparities in cardiovascular risk in the United States, 2001--2006. Ann Epidemiol 2010;20:617--28.
  25. Kurian AK, Cardarelli KM. Racial and ethnic differences in cardiovascular disease risk factors: a systematic review. Ethn Dis 2007;17:143--52.
  26. Task Force on Community Preventive Services. Guide to community preventive services. Available at http://www.thecommunityguide.org/nutrition/index.html.
  27. National Institutes of Health. National Heart Lung and Blood Institute. Cardiovascular risk reduction guidelines in adults: cholesterol guideline update (ATP IV), hypertension guideline update (JNC 8), obesity guideline update (obesity 2), integrated cardiovascular risk reduction guideline. http://www.nhlbi.nih.gov/guidelines/cvd_adult/background.htm.

TABLE 1. Number of deaths and age-adjusted death rates* for coronary heart disease and stroke, by sex and race/ethnicity --- National Vital Statistics System, United States, 2006

Characteristic

Coronary heart disease

Stroke

No.

Rate

(95% CI)

No.

Rate

(95% CI)

Sex

Female

200,915

103.1

(102.7--103.6)

82,595

42.6

(42.3--42.9)

Male

224,510

176.5

(175.7--177.2)

54,524

43.9

(43.5--44.3)

Race

American Indian/Alaska Native

1,880

97.4

(92.8--102.0)

548

29.4

(26.9--32.0)

Asian/ Pacific Islander

7,570

77.1

(75.4--78.9)

3,662

37.0

(35.8--38.2)

Black

44,530

161.6

(160.1--163.1)

17,045

61.6

(60.7--62.6)

White

371,445

134.2

(133.8--134.6)

115,864

41.7

(41.5--42.0)

Ethnicity

Hispanic

20,939

106.4

(104.9--107.8)

7,005

34.2

(33.4--35.0)

Non-Hispanic

403,588

136.8

(136.4--137.3)

129,892

44.0

(43.8--44.3)

Total

425,425

135.0

(134.6--135.4)

137,119

43.6

(43.3--43.8)

Abbreviation: CI = confidence interval.

*Per 100,000 U.S. standard population.


TABLE 2. Number of deaths and age-specific death rates* for coronary heart disease among adults aged ≥45 years, by age group, sex, and race --- National Vital Statistics System, United States, 2006

Age group (yrs)

Race

American Indian/Alaska Native

Asian/Pacific Islander

Black

White

No.

Rate

(95% CI)

No.

Rate

(95% CI)

No.

Rate

(95% CI)

No.

Rate

(95% CI)

Women

45--54

47

21.8

(16.0--29.0)

91

8.7

(7.0--10.6)

1,564

56.0

(53.2--58.8)

4,316

24.1

(23.4--24.8)

55--64

116

85.5

(69.9--101.0)

224

31.9

(27.7--36.1)

2,636

147.8

(142.1--153.4)

10,137

73.8

(72.3--75.2)

65--74

164

234.9

(199.0--270.9)

527

132.2

(120.9--143.5)

3,859

367.2

(355.6--378.8)

19,287

221.0

(217.9--224.1)

75--84

242

654.1

(571.7--736.5)

1,056

448.6

(421.5--475.7)

6,114

940.8

(917.3--964.4)

50,538

740.4

(733.9--746.8)

≥85

208

1,271.7

(1,098.9--1,444.5)

1,331

1,665.5

(1,576.0--1,754.9)

7,111

2,599.5

(2,539.1--2,660.0)

89,442

2,761.6

(2,743.6--2,779.7)

Total

777

163.8

(152.3--175.3)

3,229

130.9

(126.3--135.4)

21,284

324.9

(320.6--329.3)

173,720

344.3

(342.6--345.9)

Men

45--54

164

81.0

(68.6--93.4)

374

39.9

(35.8--43.9)

3,140

130.9

(126.3--135.5)

15,294

86.2

(84.8--87.5)

55--64

241

191.7

(167.5--215.9)

690

114.0

(105.5--122.5)

4,890

340.1

(330.6--349.7)

27,772

212.7

(210.2--215.2)

65--74

256

424.4

(372.4--476.4)

858

261.7

(244.2--279.2)

5,300

704.9

(685.9--723.9)

36,434

483.8

(478.9--488.8)

75--84

248

900.6

(788.5--1,012.7)

1,191

736.4

(694.6--778.2)

5,384

1,456.9

(1,418.0--1,495.8)

60,452

1,275.5

(1,265.3--1,285.7)

≥85

113

1,441.7

(1,175.9--1,707.5)

1,045

2,169.9

(2,038.3--2,301.5)

2,973

2,656.7

(2,561.2--2,752.2)

51,632

3,396.0

(3,366.7--3,425.3)

Total

1,022

241.1

(226.3--255.8)

4,158

199.8

(193.7--205.9)

21,687

427.8

(422.1--433.5)

191,584

429.6

(427.7--431.5)

Abbreviation: CI = confidence interval.

*Per 100,000 U.S. standard population.


TABLE 3. Number of deaths and age-specific death rates* for coronary heart disease among adults aged ≥45 years, by age group, sex, and Hispanic ethnicity --- National Vital Statistics System, United States, 2006

Age group (yrs)

Women

Men

Hispanic

Non-Hispanic

Hispanic

Non-Hispanic

No.

Rate

(95% CI)

No.

Rate

(95% CI)

No.

Rate

(95% CI)

No.

Rate

(95% CI)

45--54

345

15.5

(13.8--17.1)

5,663

28.7

(27.9--29.4)

1,205

52.7

(49.7--55.7)

17,707

93.2

(91.8--94.6)

55--64

806

60.9

(56.7--65.1)

12,273

81.6

(80.2--83.0)

1,906

156.5

(149.5--163.6)

31,564

225.4

(222.9--227.8)

65--74

1,512

199.2

(189.2--209.2)

22,270

234.7

(231.6--237.8)

2,430

394.1

(378.5--409.8)

40,266

500.0

(495.1--504.9)

75--84

3,012

666.6

(642.8--690.4)

54,839

751.6

(745.3--757.9)

3,235

1,022.8

(987.6--1,058.1)

63,916

1,282.9

(1,273.0--1,292.9)

≥85

3,694

2,213.2

(2,141.8--2,284.5)

94,269

2,739.1

(2,721.6--2,756.6)

2,176

2,453.9

(2,350.8--2,557.0)

53,499

3,344.5

(3,316.2--3,372.9)

Total

9,369

190.0

(186.2--193.9)

189,314

344.1

(342.5--345.6)

10,952

242.0

(237.5--246.5)

206,952

434.4

(432.5--436.2)

Abbreviation: CI = confidence interval.

*Per 100,000 U.S. standard population.


TABLE 4. Number of deaths and age-specific death rates* for stroke among adults aged ≥45 years, by age group, sex, and race --- National Vital Statistics System, United States, 2006

Age group (yrs)

Race

American Indian/Alaska Native

Asian/ Pacific Islander

Black

White

No.

Rate

(95% CI)

No.

Rate

(95% CI)

No.

Rate

(95% CI)

No.

Rate

(95% CI)

Women

45--54

19

---

---

109

10.4

(8.4--12.3)

875

31.3

(29.3--33.4)

1,856

10.4

(9.9--10.8)

55--64

22

16.2

(10.2--24.5)

202

28.8

(24.8--32.7)

1,090

61.1

(57.5--64.7)

3,307

24.1

(23.2--24.9)

65--74

55

78.8

(59.4--102.5)

322

80.8

(72.0--89.6)

1,565

148.9

(141.5--156.3)

6,918

79.3

(77.4--81.1)

75--84

99

267.6

(217.5--325.8)

669

284.2

(262.7--305.7)

2,701

415.6

(400.0--431.3)

21,943

321.5

(317.2--325.7)

≥85

106

648.1

(524.7--771.5)

621

777.0

(715.9--838.2)

2,901

1,060.5

(1,021.9--1,099.1)

35,698

1,102.2

(1,090.8--1,113.7)

Total

301

63.4

(56.3--70.6)

1,923

77.9

(74.5--81.4)

9,132

139.4

(136.5--142.3)

69,722

138.2

(137.1--139.2)

Men

45--54

33

16.3

(11.2--22.9)

126

13.4

(11.1--15.8)

1,044

43.5

(40.9--46.2)

2,279

12.8

(12.3--13.4)

55--64

44

35.0

(25.4--47.0)

220

36.3

(31.5--41.1)

1,523

105.9

(100.6--111.3)

4,110

31.5

(30.5--32.4)

65--74

50

82.9

(61.5--109.3)

357

108.9

(97.6--120.2)

1,644

218.7

(208.1--229.2)

7,312

97.1

(94.9--99.3)

75--84

48

174.3

(128.5--231.1)

477

294.9

(268.5--321.4)

1,741

471.1

(449.0--493.2)

16,041

338.5

(333.2--343.7)

≥85

27

344.5

(227.0--501.2)

417

865.9

(782.8--949.0)

987

882.0

(827.0--937.0)

14,311

941.3

(925.9--956.7)

Total

202

47.6

(41.1--54.2)

1,597

76.7

(73.0--80.5)

6,939

136.9

(133.7--140.1)

44,053

98.8

(97.9--99.7)

Abbreviation: CI = confidence interval.

* Per 100,000 U.S. standard population.

Number of deaths too small to calculate a reliable rate.


TABLE 5. Number of deaths and age-specific death rates* for stroke among adults aged ≥45 years, by age group, sex, and Hispanic ethnicity --- National Vital Statistics System, United States, 2006

Age group (yrs)

Women

Men

Hispanic

Non-Hispanic

Hispanic

Non-Hispanic

No.

Rate

(95% CI)

No.

Rate

(95% CI)

No.

Rate

(95% CI)

No.

Rate

(95% CI)

45--54

263

11.8

(10.4--13.2)

2,590

13.1

(12.6--13.6)

389

17.0

(15.3--18.7)

3,080

16.2

(15.6--16.8)

55--64

368

27.8

(25.0--30.7)

4,243

28.2

(27.4--29.1)

501

41.1

(37.5--44.8)

5,380

38.4

(37.4--39.4)

65--74

584

76.9

(70.7--83.2)

8,256

87.0

(85.1--88.9)

617

100.1

(92.2--108.0)

8,723

108.3

(106.0--110.6)

75--84

1,087

240.6

(226.3--254.9)

24,285

332.8

(328.6--337.0)

926

292.8

(273.9--311.6)

17,350

348.2

(343.1--353.4)

≥85

1,240

742.9

(701.6--784.3)

38,056

1,105.8

(1,094.6--1,116.9)

516

581.9

(531.7--632.1)

15,203

950.4

(935.3--965.5)

Total

3,542

71.8

(69.5--74.2)

77,430

140.7

(139.7--141.7)

2,949

65.2

(62.8--67.5)

49,736

104.4

(103.5--105.3)

Abbreviation: CI = confidence interval.

* Per 100,000 U.S. standard population.


TABLE 6. Number of deaths and age-adjusted death rates* for coronary heart disease and stroke, by state/area --- National Vital Statistics System, United States, 2006

State/Area

Coronary heart disease

Stroke

No.

Rate

(95% CI)

No.

Rate

(95% CI)

District of Columbia

1,144

193.5

(182.2--204.8)

221

37.6

(32.6--42.6)

New York

39,385

181.2

(179.4--183.0)

6,398

29.7

(29.0--30.5)

Oklahoma

6,930

177.4

(173.2--181.6)

2,085

53.3

(51.0--55.6)

Tennessee

10,602

167.8

(164.6--171.0)

3,407

54.6

(52.8--56.5)

Rhode Island

2,187

162.4

(155.5--169.3)

421

31.4

(28.4--34.5)

Arkansas

5,100

160.1

(155.7--164.5)

1,884

58.8

(56.1--61.4)

West Virginia

3,548

158.7

(153.4--163.9)

1,072

47.6

(44.7--50.5)

Michigan

16,782

156.6

(154.2--158.9)

4,752

44.5

(43.3--45.8)

Missouri

10,206

155.2

(152.2--158.2)

3,247

49.4

(47.7--51.1)

Ohio

19,820

154.0

(151.8--156.1)

5,828

45.2

(44.1--46.4)

Kentucky

6,530

148.6

(145.0--152.2)

2,197

50.5

(48.3--52.6)

Mississippi

4,354

146.7

(142.4--151.1)

1,585

53.7

(51.1--56.4)

Maryland

7,744

141.7

(138.5--144.9)

2,365

43.6

(41.8--45.4)

Iowa

5,469

141.6

(137.7--145.4)

1,718

42.9

(40.8--45.0)

New Jersey

13,684

141.2

(138.8--143.6)

3,468

35.9

(34.7--37.1)

Delaware

1,305

140.8

(133.2--148.5)

384

41.8

(37.6--46.0)

South Dakota

1,397

140.0

(132.6--147.5)

442

42.4

(38.4--46.4)

Indiana

9,210

139.7

(136.8--142.5)

3,238

49.1

(47.4--50.8)

California

46,584

139.0

(137.7--140.2)

15,039

44.9

(44.2--45.6)

Louisiana

5,919

138.3

(134.7--141.8)

2,195

52.1

(49.9--54.3)

Pennsylvania

22,030

136.0

(134.2--137.8)

7,151

43.6

(42.6--44.6)

Illinois

17,747

134.8

(132.8--136.8)

5,989

45.4

(44.3--46.6)

North Dakota

1,115

133.7

(125.7--141.8)

428

49.2

(44.5--54.0)

Texas

25,933

132.2

(130.6--133.8)

9,366

48.3

(47.3--49.3)

Florida

32,868

129.2

(127.8--130.6)

8,925

35.3

(34.5--36.0)

North Carolina

11,173

126.1

(123.8--128.5)

4,572

52.4

(50.9--53.9)

Vermont

880

124.5

(116.2--132.8)

264

37.8

(33.2--42.4)

Alabama

6,038

121.7

(118.6--124.8)

2,740

55.5

(53.4--57.6)

Arizona

7,806

120.8

(118.1--123.5)

2,226

34.5

(33.1--36.0)

Nevada

2,649

119.5

(114.9--124.1)

847

39.7

(37.0--42.4)

South Carolina

5,398

119.2

(116.0--122.4)

2,291

51.6

(49.5--53.8)

New Hampshire

1,629

116.3

(110.6--121.9)

494

35.4

(32.3--38.6)

Virginia

8,486

115.6

(113.1--118.0)

3,523

49.0

(47.3--50.6)

Washington

7,303

114.7

(112.1--117.4)

2,725

42.9

(41.3--44.6)

New Mexico

2,277

114.6

(109.9--119.3)

739

37.5

(34.8--40.2)

Kansas

3,565

114.1

(110.3--117.8)

1,489

46.7

(44.3--49.1)

Wisconsin

7,183

113.9

(111.3--116.6)

2,829

44.3

(42.7--46.0)

Maine

1,816

112.2

(107.0--117.4)

670

41.3

(38.2--44.5)

Idaho

1,565

110.2

(104.7--115.7)

725

51.6

(47.9--55.4)

Connecticut

4,630

110.0

(106.8--113.2)

1,547

36.5

(34.6--38.3)

Georgia

8,371

108.7

(106.4--111.1)

3,889

51.4

(49.8--53.1)

Wyoming

561

107.1

(98.2--116.1)

236

45.4

(39.6--51.3)

Massachusetts

8,015

105.6

(103.3--108.0)

2,880

37.7

(36.3--39.0)

Oregon

4,070

99.2

(96.1--102.3)

1,978

48.0

(45.9--50.1)

Montana

1,093

99.0

(93.0--104.9)

461

41.2

(37.4--44.9)

Colorado

3,922

96.3

(93.2--99.3)

1,532

38.7

(36.7--40.6)

Nebraska

1,861

89.9

(85.8--94.0)

922

43.9

(41.0--46.7)

Alaska

351

87.4

(77.7--97.2)

177

46.8

(39.5--54.1)

Hawaii

1,298

85.2

(80.5--89.9)

665

43.2

(39.9--46.5)

Minnesota

4,430

79.7

(77.3--82.0)

2,219

39.3

(37.7--41.0)

Utah

1,462

77.5

(73.5--81.5)

674

36.2

(33.5--38.9)

Abbreviation: CI = confidence interval.

* Per 100,000 U.S. standard population.

In order of coronary heart disease rank, from highest to lowest rate.



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