title: Modeling Future Cardiovascular Disease Mortality in the United States: National Trends and Racial and Ethnic Disparities.
abstract: BACKGROUND
  Accurate forecasting of cardiovascular disease mortality is crucial to guide policy and programming efforts. Prior forecasts often have not incorporated past trends in rates of reduction in cardiovascular disease mortality. This creates uncertainties about future trends in cardiovascular disease mortality and disparities.
  
  
  RESULTS
  To forecast US cardiovascular disease mortality and disparities to 2030, we developed a hierarchical bayesian model to determine and incorporate prior age, period, and cohort effects from 1979 to 2012, stratified by age, sex, and race, which we combined with expected demographic shifts to 2030. Data sources included the National Vital Statistics System, Surveillance, Epidemiology, and End Results (SEER) single-year population estimates, and US Bureau of Statistics 2012 national population projections. We projected coronary disease and stroke deaths to 2030, first on the basis of constant age, period, and cohort effects at 2012 values, as is most commonly done (conventional), and then with the use of more rigorous projections incorporating expected trends in age, period, and cohort effects (trend based). We primarily evaluated absolute mortality. The conventional model projected total coronary and stroke deaths by 2030 to increase by ≈18% (67 000 additional coronary deaths per year) and 50% (64 000 additional stroke deaths per year). Conversely, the trend-based model projected that coronary mortality would decrease by 2030 by ≈27% (79 000 fewer deaths per year) and stroke mortality would remain unchanged (200 fewer deaths per year). Health disparities will be improved in stroke deaths but not coronary deaths.
  
  
  CONCLUSIONS
  After prior mortality trends and expected demographic shifts are accounted for, total US coronary deaths are expected to decline, whereas stroke mortality will remain relatively constant. Health disparities in stroke but not coronary deaths will be improved but not eliminated. These age, period, and cohort approaches offer more plausible predictions than conventional estimates.
authors: From Department of Public Health and Policy, University of Liverpool, UK(J.P.-S., M.G.-C., C.K., S.C.., M.O.); Department of Primary Care and Public Health, Imperial College London, UK (J.P.-S); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA(J.L.P., C.D.R., A.A., D.M.); Harvard T.H. Chan School of Public Health, Boston, MA(G.D.); and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA(T.G.). j.pearson-stuttard@imperial.ac.uk.
authors: Jonathan
authors: J
authors: Pearson-Stuttard
authors: From Department of Public Health and Policy, University of Liverpool, UK(J.P.-S., M.G.-C., C.K., S.C.., M.O.); Department of Primary Care and Public Health, Imperial College London, UK (J.P.-S); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA(J.L.P., C.D.R., A.A., D.M.); Harvard T.H. Chan School of Public Health, Boston, MA(G.D.); and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA(T.G.).
authors: Maria
authors: M
authors: Guzman-Castillo
authors: From Department of Public Health and Policy, University of Liverpool, UK(J.P.-S., M.G.-C., C.K., S.C.., M.O.); Department of Primary Care and Public Health, Imperial College London, UK (J.P.-S); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA(J.L.P., C.D.R., A.A., D.M.); Harvard T.H. Chan School of Public Health, Boston, MA(G.D.); and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA(T.G.).
authors: Jose L
authors: JL
authors: Penalvo
authors: From Department of Public Health and Policy, University of Liverpool, UK(J.P.-S., M.G.-C., C.K., S.C.., M.O.); Department of Primary Care and Public Health, Imperial College London, UK (J.P.-S); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA(J.L.P., C.D.R., A.A., D.M.); Harvard T.H. Chan School of Public Health, Boston, MA(G.D.); and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA(T.G.).
authors: Colin D
authors: CD
authors: Rehm
authors: From Department of Public Health and Policy, University of Liverpool, UK(J.P.-S., M.G.-C., C.K., S.C.., M.O.); Department of Primary Care and Public Health, Imperial College London, UK (J.P.-S); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA(J.L.P., C.D.R., A.A., D.M.); Harvard T.H. Chan School of Public Health, Boston, MA(G.D.); and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA(T.G.).
authors: Ashkan
authors: A
authors: Afshin
authors: From Department of Public Health and Policy, University of Liverpool, UK(J.P.-S., M.G.-C., C.K., S.C.., M.O.); Department of Primary Care and Public Health, Imperial College London, UK (J.P.-S); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA(J.L.P., C.D.R., A.A., D.M.); Harvard T.H. Chan School of Public Health, Boston, MA(G.D.); and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA(T.G.).
authors: Goodarz
authors: G
authors: Danaei
authors: From Department of Public Health and Policy, University of Liverpool, UK(J.P.-S., M.G.-C., C.K., S.C.., M.O.); Department of Primary Care and Public Health, Imperial College London, UK (J.P.-S); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA(J.L.P., C.D.R., A.A., D.M.); Harvard T.H. Chan School of Public Health, Boston, MA(G.D.); and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA(T.G.).
authors: Chris
authors: C
authors: Kypridemos
authors: From Department of Public Health and Policy, University of Liverpool, UK(J.P.-S., M.G.-C., C.K., S.C.., M.O.); Department of Primary Care and Public Health, Imperial College London, UK (J.P.-S); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA(J.L.P., C.D.R., A.A., D.M.); Harvard T.H. Chan School of Public Health, Boston, MA(G.D.); and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA(T.G.).
authors: Tom
authors: T
authors: Gaziano
authors: From Department of Public Health and Policy, University of Liverpool, UK(J.P.-S., M.G.-C., C.K., S.C.., M.O.); Department of Primary Care and Public Health, Imperial College London, UK (J.P.-S); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA(J.L.P., C.D.R., A.A., D.M.); Harvard T.H. Chan School of Public Health, Boston, MA(G.D.); and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA(T.G.).
authors: Dariush
authors: D
authors: Mozaffarian
authors: From Department of Public Health and Policy, University of Liverpool, UK(J.P.-S., M.G.-C., C.K., S.C.., M.O.); Department of Primary Care and Public Health, Imperial College London, UK (J.P.-S); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA(J.L.P., C.D.R., A.A., D.M.); Harvard T.H. Chan School of Public Health, Boston, MA(G.D.); and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA(T.G.).
authors: Simon
authors: S
authors: Capewell
authors: From Department of Public Health and Policy, University of Liverpool, UK(J.P.-S., M.G.-C., C.K., S.C.., M.O.); Department of Primary Care and Public Health, Imperial College London, UK (J.P.-S); Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA(J.L.P., C.D.R., A.A., D.M.); Harvard T.H. Chan School of Public Health, Boston, MA(G.D.); and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA(T.G.).
authors: Martin
authors: M
authors: O'Flaherty
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality*; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D005544:Forecasting; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009026:Mortality / Q000639:trends; D044469:Racial Groups / Q000208:ethnology*; D012307:Risk Factors; D018426:SEER Program / Q000639:trends; D014481:United States / Q000208:ethnology
keywords: cardiovascular diseases; ethnic groups; mortality; population groups; projections and predictions