Population Trends Model Predicts Major Drop in US Coronary Deaths by 2030

Given the growing and ageing US population and the fact that healthcare is at the forefront of the ongoing presidential race, a new study modelling decreased coronary disease mortality and unchanged stroke mortality through 2030 may have potential implications for policy makers.

Previous reports using population data in the United States have estimated increasing rates of both cardiovascular disease- and stroke-related death, but these projections “assumed that mortality rates simply persist unchanged” through time, according to Jonathan Pearson-Stuttard, MA, BM, BCh, of Imperial College London (England), and colleagues.

Using information from the National Vital Statistics System, SEER database, and the US Bureau of Statistics, the authors developed 2 Bayesian models which look at mortality trends through 2030. The first—called the conventional projection—is similar to what has been done in the past, but the second model—a trend-based projection—incorporated age, period, and cohort effects to continue as they were observed from 1979 through 2012.

While the conventional model projected increases of 18% and 50%, respectively, in coronary and stroke mortality rates by 2030 (accounting for 67,000 and 64,000 additional deaths), the trend-based model showed coronary deaths falling by about 27% (79,000 fewer deaths) and stroke death remaining constant over the same period.

“By far the greatest contribution to [cardiovascular disease] mortality was the age effect, followed by the period, and then the cohort effect,” Pearson-Stuttard and colleagues write. Middle aged patients (45-54 years) were found to be the most at risk for death caused by coronary heart disease. “This was consistent across races and ethnicities; however the cohort effect was minimal in non-Hispanic blacks and Hispanics.”

Given what the trend-based models show in the coming years, “the potential growing burden of projected population growth and demographic changes forecasted for the US by the US Bureau could be countered by rapidly declining [cardiovascular disease] mortality rates,” they write, adding that it is possible that previous projections overestimated the “future burden” of mortality.

Implications for Government

More analyses using trend-based models could be helpful as policy writers prepare to “tackle the projected ageing population,” the authors suggest. By implementing systems changes as they relate to alcohol, smoking, and diet, government officials could potentially continue curbing cardiovascular disease mortality.

That said, however, “the absence of improvements in racial disparities urgently needs to be addressed by policy makers,” they say.

Whether or not predictions like these will prove accurate will not be known until the future is the present, commented Russell V. Luepker, MS, of the University of Minnesota (Minneapolis, MN), in an interview with TCTMD. “That’s always the problem with prediction in a constantly changing universe,” he said, adding that on top of changes in age and racial distribution throughout the country, treatments and habits evolve as well.

He likened the situation to how the recent Iowa caucus and New Hampshire primary may or may not predict the ultimate candidate elected President come November. “Things like that are difficult to predict with any certainty,” Luepker said.

Although the study was focused on US trends, he points out that the authors are British and live in a place with a universal healthcare system that allocates resources based on prediction models like this. The current state of the US healthcare system, he says, negates the possibility to truly use information from models to an effective degree, he implied.

That is not to say that projections are useless, however. “We need to have a debate about things like this,” Luepker said, adding that the ageing population is a serious consideration for policy makers and physicians alike. “[The researchers] put that on the table, and from a scientific and epidemiologic point of view, they have some thoughtful modeling that includes more factors than other people have [included] before and presumably gives a more accurate presentation.”

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Source: 
Pearson-Stuttard J, Guzman-Castillo M, Penalvo JL, et al. Modelling future cardiovascular disease mortality in the United States: national trends and racial and ethnic disparities. Circulation. 2016;Epub ahead of print.

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