title: Changes in the Geographic Patterns of Heart Disease Mortality in the United States: 1973 to 2010.
abstract: BACKGROUND
  Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality.
  
  
  RESULTS
  Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged ≥35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases. A fully Bayesian spatiotemporal model was used to produce precise rate estimates, even in counties with small populations. A substantial shift in the concentration of high-rate counties from the Northeast to the Deep South was observed, along with a concentration of slow-decline counties in the South and a nearly 2-fold increase in the geographic inequality among counties.
  
  
  CONCLUSIONS
  The dramatic change in the geographic patterns of heart disease mortality during 40 years highlights the importance of small-area surveillance to reveal patterns that are hidden at the national level, gives communities the historical context for understanding their current burden of heart disease, and provides important clues for understanding the determinants of the geographic disparities in heart disease mortality.
authors.affiliation: From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.). mcasper@cdc.gov.
authors.forename: Michele
authors.initials: M
authors.lastname: Casper
authors.affiliation: From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.).
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kramer
authors.affiliation: From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.).
authors.forename: Harrison
authors.initials: H
authors.lastname: Quick
authors.affiliation: From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.).
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Schieb
authors.affiliation: From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.).
authors.forename: Adam S
authors.initials: AS
authors.lastname: Vaughan
authors.affiliation: From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.).
authors.forename: Sophia
authors.initials: S
authors.lastname: Greer
mesh_terms: D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D005260:Female; D062306:Geography, Medical; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009026:Mortality / Q000639:trends; D011159:Population Surveillance; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: epidemiology; heart diseases; mapping; mortality