Trends and Disparities in Cardiovascular Mortality Among U.S. Adults With and Without Self-Reported Diabetes, 1988–2015

Abstract

OBJECTIVE Cardiovascular disease (CVD) mortality has declined substantially in the U.S. The aims of this study were to examine trends and demographic disparities in mortality due to CVD and CVD subtypes among adults with and without self-reported diabetes. RESEARCH DESIGN AND METHODS We used the National Health Interview Survey (NHIS) (1985–2014) with mortality follow-up data through the end of 2015 to estimate nationally representative trends and disparities in major CVD, ischemic heart disease (IHD), stroke, heart failure, and arrhythmia mortality among adults ≥20 years of age by diabetes status. RESULTS Over a mean follow-up period of 11.8 years from 1988 to 2015 of 677,051 adults, there were significant decreases in major CVD death (all P values <0.05) in adults with and without diabetes except adults 20–54 years of age. Among adults with diabetes, 10-year relative changes in mortality were significant for major CVD (−32.7% [95% CI −37.2, −27.9]), IHD (−40.3% [−44.7, −35.6]), and stroke (−29.2% [−40.0, −16.5]), but not heart failure (−0.5% [−20.7, 24.7]), and arrhythmia (−12.0% [−29.4, 77.5]); the absolute decrease of major CVD among adults with diabetes was higher than among adults without diabetes (P < 0.001). Men with diabetes had larger decreases in CVD death than women with diabetes (P < 0.001). CONCLUSIONS Major CVD mortality in adults with diabetes has declined, especially in men. Large reductions were observed for IHD and stroke mortality, although heart failure and arrhythmia deaths did not change. All race and education groups benefitted to a similar degree, but significant gaps remained across groups.