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Rural congestive heart failure mortality among US elderly, 1999-2013: Identifying counties with promising outcomes and opportunities for implementation research

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Family Medicine and Community Health 2015年第2期3卷 27-38页

作者： Maria C.Mejia de Grubb Robert S.Levine Barbara Kilbourne Baqar A.Husaini tyler skelton Lisa Gittner Michael A.Langston George E.Rust Department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA Department of Sociology Tennessee State UniversityNashvilleTennesseeUSA Center for PreventionResearch Tennessee State University College of AgricultureNashvilleTennesseeUSA Department of Political Science Texas Tech UniversityLubbockTXUSA Department of Electrical Engineering and Computer Science University of TennesseeKnoxvilleTennesseeUSA Department of Family Medicine National Center for Primary CareMorehouse School of MedicineAtlantaGeorgiaUSA

Objective:Describe modern trends in congestive heart failure(CHF)among elderly(>65 years of age)in the United States,to identify potentially successful rural areas.Compare CHF mortality using multiple-(MCOD)versus underlying-(UCOD)cause of death data.Methods:U.S.Centers for Disease Control and Prevention mortality files(WONDER internet site).Results:Using MCOD data,overall mortality rates/100,000 population(and 95%confidence intervals)for CHF among persons>65 years of age(1999-2013)were 482.0(481.2-482.8)for large central and large fringe metropolitan(LCLF)counties,549.6(548.6-550.7)in small and medium metropolitan(SM)counties,and 652.6(650.9-654.0)in micropolitan and non-core,non-metropolitan(MNCNM)counties.Twenty positive deviance NCNM counties(collectively including 198,581 residents>65 years of age)had an overall CHF rate of 300.9(275.0-326.9)in 2013.This was significantly lower than the LCLF rate for 2013(482.0[481.2-482.8]),and rep-resented a reduction of 47%since 1999.Overall CHF occurrence as estimated with MCOD was 3.4-fold higher than that obtained with UCOD.Conclusion:These data illustrate underestimation of CHF by UCOD data and the importance of correct death certification.Rural CHF mortality rates are higher than urban rates,but some positive deviance counties demonstrate that this is not inevitable.Further research is needed to understand the relative contribution of research innovation,medical care,and public health to rural-urban disparities and the relative success of positive deviance counties.

关键词： Congestive heart failure elderly mortality rural

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