Who is Most Prone to Fatal Premature Heart Attacks?

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Who is Most Prone to Fatal Premature Heart Attacks?       

Jim Windell

            Living in the city will kill you, right? On the other hand, living in rural areas – parts of the country that are peaceful and serene – will help you live a longer, healthier life.

            These are ingrained beliefs for many Americans. But are they true? And are they backed up by evidence?

            A recent study published in the Journal of the American Heart Association takes a look at the rates of premature heart attack deaths to determine who dies early and where they live.

            According to lead study author Safi U. Khan, M.D., M.S., a cardiology fellow at the DeBakey Heart and Vascular Institute at Houston Methodist Hospital in Houston, “The cardiovascular risks among adults younger than age 65 has become increasingly complex during the last two decades. Our study focused explicitly on premature deaths due to a heart attack to identify demographic and regional differences, which may help to inform targeted interventions.”

           Khan and his associates reviewed the Centers for Disease Control and Prevention (CDC) Wide-Ranging OnLine Data for Epidemiologic Research (WONDER) database to examine premature death rates in adults younger than age 65 across the U.S. The data indicates that between 1999 and 2019, premature heart attack was listed as the primary cause of death for more than 615,000 people in the U.S.

           "Cardiovascular disease is the leading cause of death in the United States, and acute myocardial infarction or heart attack, is a major contributor,” notes Khan.

           The results of the study show that  middle-aged adults, men, Black adults and adults living in rural counties have significantly higher heart attack death rates before the age of 65 than women, white adults and people living in urban counties.

           The analysis found significant demographic and regional disparities in premature death rates due to heart attack:

  • Death rates were nearly 3 times higher among men than women (20.0 vs. 7.3 per 100,000 person-years for men vs. women, respectively).
  • Death rates were higher among Black adults than white adults (17.5 vs. 13.7 per 100,000 person-years, respectively).
  • There were higher death rates in Southern states (Arkansas, Mississippi, Kentucky, Louisiana and Tennessee) compared to Western and Northeastern states.
  • Middle-aged adults (ages 45-64) had higher death rates than younger adults (ages 18-44) (34.9 vs. 2.5 per 100,000 person-years, respectively).
  • Premature death rates in rural counties were higher than in urban counties – the average annual percent decline in heart attack deaths among those younger than 65 was -4.2 per year in large metro areas compared to only -2.4 per year in rural counties.

           If the myth of the good health of people living in rural areas is shattered, what leads to better health of people living in urban areas?

           Khan suggests that these trends highlight health care disparities among people from diverse racial and ethnic backgrounds. For example, people with low socioeconomic status often have a higher prevalence of being without health insurance and may also suffer from a higher prevalence of cardiovascular risk factors, such as smoking, hyperlipidemia, Type 2 diabetes, and high blood pressure, among racial/ethnic minorities. These risk factors widened the health gap for people from diverse racial and ethnic groups.

           Additionally, people living in rural areas were more likely to have limited access to health care. That in itself may influence the death rate due to heart attack among younger adults.

          Although the study found that the premature death rate decreased by 4.3% per year from 1999 to 2011, the rate of decline slowed to 2.1% per year between 2011 and 2019. These patterns were consistent regardless of age, sex, ethnicity/race and across all U.S. counties.

          Dr. Khan said this concerning trend reflects the growing burden of cardiovascular disease among younger adults. This might suggest both obesity and widening socioeconomic disparities that lead to premature cardiovascular disease. And it may indicate the need for education campaigns to target young adult men in rural areas.

           However, it seems incumbent on society to address gaping holes in public health infrastructure laid bare by the COVID pandemic.

           To read the original article, find it with this reference:

Dani, S. S., Lone, A. N., Javed, Z., Khan, M. S., Zia Khan, M., Kaluski, E., ... & Khan, S. U. (2021). Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019. Journal of the American Heart Association, e021682.



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