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

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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 represented 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.

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Keywords: Congestive heart failure; elderly; mortality; rural

Document Type: Research Article

Publication date: 2015-06-01

More about this publication?
  • Family Medicine and Community Health (FMCH) is an open-access journal focusing on subjects that are common and relevant to family medicine/general practice and community health. The journal publishes relevant content across disciplines such as epidemiology, public health, social and preventive medicine, research and evidence based medicine, community health service, patient education and health promotion and health ethics. The journal has a specific focus on the management of chronic illness particularly diabetes, ischaemic heart disease, chronic heart failure, hypertension, bronchial asthma, chronic obstructive airways disease and common mental illness. FMCH is published by Compuscript http://www.compuscript.com on behalf of the Chinese General Practice Press http://www.chinagp.net.

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