What is the distribution of Coronary Heart Disease (CHD) frequencies across different demographics and geographic locations?

Distribution of Coronary Heart Disease (CHD) Frequencies Across Demographics and Geographic Locations

Coronary heart disease (CHD) affects approximately 20.1 million people in the United States (7.2% of adults aged 20 years and older), with significant variations across demographic groups and geographic regions. 1

Global Distribution

• CHD is the leading cause of death in the United States and worldwide, despite an approximate 25% overall relative decline in CHD mortality over the past decade 1
• The geographic incidence of sudden cardiac death (SCD) varies as a function of CHD prevalence in different regions, with estimates for the United States ranging from 300,000 to 350,000 SCDs annually 1
• Event rates in Europe are similar to those in the United States, with significant geographic variations reported 1
• Approximately 50% of all CHD deaths are sudden and unexpected, occurring shortly (instantaneous to 1 hour) after the onset of a change in clinical status 1
• CHD is a growing epidemic in low- and middle-income countries, with three-fourths of global deaths due to CHD occurring in these regions 2

Distribution by Sex

• In the United States, CHD affects 11 million men (8.3%) and 9.1 million women (6.2%) 1
• Myocardial infarction (MI) prevalence is higher in men (4.3%) compared to women (2.1%) 1
• Angina pectoris affects 5.3 million men (4.2%) and 5.7 million women (4.0%) 1

Distribution by Race and Ethnicity in the United States

• Non-Hispanic White men: 8.7% CHD prevalence, 4.4% MI prevalence, 4.5% angina prevalence 1
• Non-Hispanic White women: 6.0% CHD prevalence, 2.0% MI prevalence, 4.0% angina prevalence 1
• Non-Hispanic Black men: 6.7% CHD prevalence, 3.9% MI prevalence, 3.3% angina prevalence 1
• Non-Hispanic Black women: 7.2% CHD prevalence, 2.3% MI prevalence, 4.7% angina prevalence 1
• Hispanic men: 6.8% CHD prevalence, 3.7% MI prevalence, 3.5% angina prevalence 1
• Hispanic women: 6.4% CHD prevalence, 2.1% MI prevalence, 4.3% angina prevalence 1
• Non-Hispanic Asian men: 5.0% CHD prevalence, 2.7% MI prevalence, 2.1% angina prevalence 1
• Non-Hispanic Asian women: 3.2% CHD prevalence, 0.7% MI prevalence, 2.2% angina prevalence 1

Geographic Variations Within the United States

• Areas near the Ohio and lower Mississippi Rivers have above-average CHD rates, particularly among European Americans 3, 4
• In 2007, age-adjusted death rates per 100,000 for CHD ranged from 93 in European American women in New England to 345 in African American men in the East North Central division 3
• High CHD rates are particularly prevalent in the lower Mississippi valley and Oklahoma for all demographic groups 4
• The Ohio River valley and New York show high rates for whites and to a lesser extent for blacks 4

Urban-Rural Differences

• For African Americans in the East North Central division, annual percent change (APC) in CHD mortality was similar in large central metro (-4.2%), large fringe metro (-4.3%), medium metro (-4.4%), and small metro (-3.9%) areas 3
• Higher declines were observed in micropolitan/non-metro (-5.3%) and non-core/non-metro (-6.5%) areas for African Americans 3
• For European Americans in the East South Central division, APC was higher in large central metro (-5.3%), large fringe metro (-4.3%), and medium metro (-5.1%) than in small metro (-3.8%), micropolitan/non-metro (-4.0%), and non-core/non-metro (-3.3%) areas 3

Social Determinants of Health and CHD

• Social vulnerability explains a significant portion of geographic variation in CHD and its risk factors 5
• Neighborhoods with high social vulnerability are at disproportionately increased risk of CHD 5
• Socioeconomic status and household composition/disability are the social vulnerability themes most closely associated with cardiovascular risk factors and CHD prevalence 5
• Lower socioeconomic status is associated with higher CHD prevalence and worse outcomes 5

Temporal Trends

• Between 1999 and 2007, CHD mortality rates declined in both African Americans and European Americans across all geographic divisions, though relative declines varied 3
• Relative average annual declines ranged from 3.2% to 4.7% in African American men and from 4.4% to 5.5% in European American men across geographic divisions 3
• In women, rates declined more in later years of the decade and in women over 54 years 3
• Despite declining age-adjusted CHD mortality, the absolute numbers of cardiac deaths are not decreasing due to population growth and aging 1

Impact on Health-Related Quality of Life

• CHD is associated with significant impairment of health-related quality of life across all demographic groups 6
• Differences in health status impairment exist across different age, racial, and ethnic groups 6
• Compared with whites, the differences in health-related quality of life between CHD and non-CHD populations are larger in blacks across most measures 6

Clinical Implications

• The varying incidence, prevalence, and mortality rates reflect different levels of risk factors, competing causes of death, availability of resources, and the stage of epidemiologic transition in each region 2
• Understanding these geographic and demographic variations is essential for developing targeted interventions to reduce CHD burden in high-risk populations 4, 5