Rural congestive heart failure mortality among US elderly, 1999‐2013: Identifying counties with promising outcomes and opportunities for implementation research
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.
Document Type: Research Article
Publication date: 01 June 2015
This article was made available online on 29 June 2015 as a Fast Track article with title: "Rural congestive heart failure mortality among US elderly, 1999–2013: Identifying counties with promising outcomes and opportunities for implementation research".
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