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May 2018

Geographic Variation in Cardiovascular Disease Burden: Clues and Questions

Author Affiliations
  • 1Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
JAMA Cardiol. 2018;3(5):366-368. doi:10.1001/jamacardio.2018.0387

In October 1978, a conference was convened by the National Institutes of Health to discuss the decline in coronary heart disease (CHD) mortality rates in the United States during the previous decade.1 The purpose of the conference was to consider whether the decline was real, discuss the possible causes, and recommend further studies to elucidate these causes. The conference was a watershed event that launched several major population-based, observational studies in the United States and internationally, including the Atherosclerosis Risk in Communities Study2 in the United States and the World Health Organization–Monitoring Trends and Determinants in Cardiovascular Disease Project3 in 21 countries in the mid-1980s. A focus of studies prompted by the conference was to better understand the abrupt decrease in CHD mortality rates as well as investigating geographic variation in CHD trends. In 1986, Wing et al4 reported that the onset of the decline in CHD mortality in the United States began in metropolitan areas before nonmetropolitan areas. They also reported that the timing of the onset of the decline was independent of a region’s absolute CHD morality rate; mid-Atlantic regions (with high rates) and Pacific regions (with low rates) experienced early onset of the decline, while much of the south (with high rates) and mountain regions (with low rates) had later onset of the decline.4