QuickStats: Age-Adjusted Death Rates,* by Race/Ethnicity† — National Vital Statistics System, United States, 2014–2015

Objectives: The purpose of this study was to quantify rural and metropolitan trends in premature heart disease (HD) mortality using the most up-to-date data available (through 2013). To our knowledge this is the first study to analyze these geographic disparities for Hispanics (HSP), Asians/Pacific Islanders (API), and American Indians/Alaska Natives (AI/AN). Methods: Annual age-adjusted HD death rates for adults aged 25-64 years were analyzed for 2000-2013. Rates were calculated for 5 racial/ethnic groups (Non-Hispanic Whites (WNH), Non-Hispanic Blacks (BNH), HSP of any race, Non-Hispanic API, and Non-Hispanic AI/AN). County-level data were aggregated by urbanicity: large central metro (LCM), large fringe metro (LFM), medium/small metro (MSM), and micropolitan/rural (RURAL). Region was defined as South (16 states) and Non-South. All data were obtained from the National Vital Statistics System on CDC WONDER. Average annual percent change (AAPC) was calculated by linear regression of the log-transformed death rates using SAS 9.4. Results: In 2013, the national population-at-risk predominantly resided in metro areas. However, there were more than 10 million RURAL adults aged 25-64 years in the South (16.2% of the region) and more than 13.4 million in the non-South (12.9% of the region). Nationwide, HD death rates were lowest in the LFM counties. In the South, the rate ratio (RR) for RURAL vs. LFM areas in 2011-2013 was 1.76 (95% CI 1.73 to 1.79) for WNH, 2.00 (95% CI 1.85 to 2.16) for HSP, 1.78 (95%CI 1.71 to 1.82) for BNH, 1.57 (95% CI 1.22 to 2.03) for API, and 3.13 (95% CI 2.47 to 3.96) for NNH. In the non-South, RURAL vs. LFM RRs were smaller, with the exception of API (RR 2.37, 95% CI 2.07 to 2.71). Temporal trend analyses revealed significantly smaller AAPC in RURAL areas (see Table). Conclusions: Higher death rates coupled with slower declines have resulted in a widening rural disadvantage in premature HD mortality in the United States from 2000 to 2013, particularly for WNH, HSP, BNH, and AI/AN in the South, and WNH in the non-South.

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Differential Association of HIV Funding With HIV Mortality by Race/Ethnicity, United States, 1999-2017

Public Health Reports ◽

10.1177/0033354920912716 ◽

2020 ◽

Vol 135 (1_suppl) ◽

pp. 149S-157S

Author(s):

Benedict I. Truman ◽

Ramal Moonesinghe ◽

Yolanda T. Brown ◽

Man-Huei Chang ◽

Jonathan H. Mermin ◽

...

Keyword(s):

United States ◽

The United States ◽

Rate Of Change ◽

Fiscal Year ◽

Death Rates ◽

Black Residents ◽

Race Ethnicity ◽

Hiv Funding ◽

Racial Ethnic ◽

Hispanic White

Objective Federal funds have been spent to reduce the disproportionate effects of HIV/AIDS on racial/ethnic minority groups in the United States. We investigated the association between federal domestic HIV funding and age-adjusted HIV death rates by race/ethnicity in the United States during 1999-2017. Methods We analyzed HIV funding data from the Kaiser Family Foundation by federal fiscal year (FFY) and US age-adjusted death rates (AADRs) by race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, and Asian/Pacific Islander and American Indian/Alaska Native [API+AI/AN]) from Centers for Disease Control and Prevention WONDER detailed mortality files. We fit joinpoint regression models to estimate the annual percentage change (APC), average APC, and changes in AADRs per billion US dollars in HIV funding, with 95% confidence intervals (CIs). For 19 data points, the number of joinpoints ranged from 0 to 4 on the basis of rules set by the program or by the user. A Monte Carlo permutation test indicated significant ( P < .05) changes at joinpoints, and 2-sided t tests indicated significant APCs in AADRs. Results Domestic HIV funding increased from $10.7 billion in FFY 1999 to $26.3 billion in FFY 2017, but AADRs decreased at different rates for each racial/ethnic group. The average rate of change in AADR per US billion dollars was −9.4% (95% CI, −10.9% to −7.8%) for Hispanic residents, −7.8% (95% CI, −9.0% to −6.6%) for non-Hispanic black residents, −6.7% (95% CI, −9.3% to −4.0%) for non-Hispanic white residents, and −5.2% (95% CI, −7.8% to −2.5%) for non-Hispanic API+AI/AN residents. Conclusions Increased domestic HIV funding was associated with faster decreases in age-adjusted HIV death rates for Hispanic and non-Hispanic black residents than for residents in other racial/ethnic groups. Increasing US HIV funding could be associated with decreasing future racial/ethnic disparities in the rate of HIV-related deaths.

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