Cardiovascular Disease Projections in the United States Based on the 2020 Census Estimates
Original Investigation
Central Illustration
Abstract
Background
Understanding trends in cardiovascular (CV) risk factors and CV disease according to age, sex, race, and ethnicity is important for policy planning and public health interventions.
Objectives
The goal of this study was to project the number of people with CV risk factors and disease and further explore sex, race, and ethnical disparities.
Methods
The prevalence of CV risk factors (diabetes mellitus, hypertension, dyslipidemia, and obesity) and CV disease (ischemic heart disease, heart failure, myocardial infarction, and stroke) according to age, sex, race, and ethnicity was estimated by using logistic regression models based on 2013-2018 National Health and Nutrition Examination Survey data and further combining them with 2020 U.S. Census projection counts for years 2025-2060.
Results
By the year 2060, compared with the year 2025, the number of people with diabetes mellitus will increase by 39.3% (39.2 million [M] to 54.6M), hypertension by 27.2% (127.8M to 162.5M), dyslipidemia by 27.5% (98.6M to 125.7M), and obesity by 18.3% (106.3M to 125.7M). Concurrently, projected prevalence will similarly increase compared with 2025 for ischemic heart disease by 31.1% (21.9M to 28.7M), heart failure by 33.0% (9.7M to 12.9M), myocardial infarction by 30.1% (12.3M to 16.0M), and stroke by 34.3% (10.8M to 14.5M). Among White individuals, the prevalence of CV risk factors and disease is projected to decrease, whereas significant increases are projected in racial and ethnic minorities.
Conclusions
Large future increases in CV risk factors and CV disease prevalence are projected, disproportionately affecting racial and ethnic minorities. Future health policies and public health efforts should take these results into account to provide quality, affordable, and accessible health care.
References
1. "The epidemiologic transition theory". J Epidemiol Commun Health 1994;48:4: 329.
2. "The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases". Milbank Q 1986. 355-391.
3. "Prevalence of high body mass index in US children and adolescents, 2007-2008". JAMA 2010;303:3: 242-249.
4. "Trends in incidence of total or type 2 diabetes: systematic review". BMJ 2019;366:l5003. https://doi.org/10.1136/bmj.l5003.
5. "Heart disease and stroke statistics—2021 update: a report from the American Heart Association". Circulation 2021;143:8: e254-e743. https://doi.org/10.1161/CIR.0000000000000950.
6. "Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association". Circulation 2015;132:9: 873-898. https://doi.org/10.1161/CIR.0000000000000228.
7. "Projections of the size and composition of the U.S. population: 2014 to 2060". Curr Pop Rep 2015. 1125-1143.
8. "U.S. Census Bureau releases national population projections reports on life expectancy and alternative migration scenarios". Accessed
February 13, 2020 . https://www.census.gov/newsroom/press-releases/2020/population-projections.html.9. "Population projections for 2020 to 2060". https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf.
10. "Trends in prevalence of type 1 and type 2 diabetes in children and adolescents in the US, 2001-2017". JAMA 2021;326:8: 717-727. https://doi.org/10.1001/jama.2021.11165.
11. "Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth—United States, 2012-2016". MMWR Morb Mortal Wkly Rep 2018;67:43: 1201-1207. https://doi.org/10.15585/mmwr.mm6743a2.
12. "Role of environmental chemicals in diabetes and obesity: a National Toxicology Program workshop review". Environ Health Perspect 2012;120:6: 779-789. https://doi.org/10.1289/ehp.1104597.
13. "Hypertension awareness, treatment, and control in US adults: trends in the hypertension control cascade by population subgroup (National Health and Nutrition Examination Survey, 1999-2016)". Am J Epidemiol 2019;188:12: 2165-2174. https://doi.org/10.1093/aje/kwz177.
14. "Adult obesity facts". https://www.cdc.gov/obesity/data/adult.html.
15. "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". J Am Coll Cardiol 2019;73:24: e285-e350.
16. "Projected U.S. state-level prevalence of adult obesity and severe obesity". N Engl J Med 2019;381:25: 2440-2450. https://doi.org/10.1056/NEJMsa1909301.
17. "Cardiovascular health in African Americans: a scientific statement from the American Heart Association". Circulation 2017;136:21: e393-e423. https://doi.org/10.1161/CIR.0000000000000534.
18. "Representation of Black patients in heart failure clinical trials". Curr Opin Cardiol 2021;36:3: 329-334. https://doi.org/10.1097/HCO.0000000000000849.
19. "Racial and ethnic disparities in heart failure: current state and future directions". Curr Opin Cardiol 2021;36:3: 320-328. https://doi.org/10.1097/HCO.0000000000000855.
20. "Association of black race with early recurrence after minor ischemic stroke or transient ischemic attack: secondary analysis of the POINT randomized clinical trial". JAMA Neurol 2020;77:5: 601-605. https://doi.org/10.1001/jamaneurol.2020.0010.
21. "Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association". Circulation 2011;123:8: 933-944. https://doi.org/10.1161/CIR.0b013e31820a55f5.
22. "Cardiovascular health behavior and health factor changes (1988-2008) and projections to 2020: results from the National Health and Nutrition Examination Surveys". Circulation 2012;125:21: 2595-2602. https://doi.org/10.1161/CIRCULATIONAHA.111.070722.
23. "More Americans living longer with cardiovascular disease will increase costs while lowering quality of life". Health Aff (Millwood) 2013;32:10: 1706-1714. https://doi.org/10.1377/hlthaff.2013.0449.
24. "A policy prescription for reducing health disparities—achieving pharmacoequity". JAMA 2021;326:18: 1793-1794. https://doi.org/10.1001/jama.2021.17764.
25. "Socioeconomic status and cardiovascular outcomes: challenges and interventions". Circulation 2018;137:20: 2166-2178. https://doi.org/10.1161/CIRCULATIONAHA.117.029652.
26. "Structural racism and health inequities in the USA: evidence and interventions". Lancet 2017;389:10077: 1453-1463. https://doi.org/10.1016/s0140-6736(17)30569-x.
27. "Global estimates of diabetes prevalence for 2013 and projections for 2035". Diabetes Res Clin Pract 2014;103:2: 137-149. https://doi.org/10.1016/j.diabres.2013.11.002.
28. "Predicting coronary heart disease mortality—assessing uncertainties in population forecasts and death probabilities by using Bayesian inference". Int J Epidemiol 2006;35:5: 1246-1252. https://doi.org/10.1093/ije/dyl128.
29. "The impact of the aging population on coronary heart disease in the United States". Am J Med 2011;124:9: 827-833. https://doi.org/10.1016/j.amjmed.2011.04.010.e5.
30. "Quantifying options for reducing coronary heart disease mortality by 2020". Circulation 2013;127:25: 2477-2484. https://doi.org/10.1161/CIRCULATIONAHA.112.000769.
31. "Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association". Circ Heart Fail 2013;6:3: 606-619. https://doi.org/10.1161/HHF.0b013e318291329a.
32. "Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association". Stroke 2013;44:8: 2361-2375. https://doi.org/10.1161/STR.0b013e31829734f2.
33. "Projections of cardiovascular disease prevalence and costs". https://www.heart.org/-/media/Files/Get-Involved/Advocacy/CVD-Predictions-Through-2035.pdf.
34. "COVID data tracker". https://covid.cdc.gov/covid-data-tracker/#datatracker-home.
35. "The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States". Clin Infect Dis 2021;72:4: 703-706. https://doi.org/10.1093/cid/ciaa815.
36. "National trends in racial and ethnic disparities in antihypertensive medication use and blood pressure control among adults with hypertension, 2011-2018". Hypertension 2022;79:1: 207-217. https://doi.org/10.1161/HYPERTENSIONAHA.121.18381.
37. "Trends in the prevalence of self-reported heart failure by race/ethnicity and age from 2001 to 2016". JAMA Cardiol 2020;5:12: 1425-1429. https://doi.org/10.1001/jamacardio.2020.3654.
38. "Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study". Arch Intern Med 2001;161:7: 996-1002. https://doi.org/10.1001/archinte.161.7.996.
39. "Prospective assessment of coronary heart disease risk factors: the NHANES I Epidemiologic Follow-Up Study (NHEFS) 16-year follow-up". J Am Coll Nutr 1998;17:3: 263-269. https://doi.org/10.1080/07315724.1998.10718757.
40. "Trends in cardiovascular disease risk factors by obesity level in adults in the United States, NHANES 1999-2010". Obesity (Silver Spring) 2014;22:8: 1888-1895. https://doi.org/10.1002/oby.20761.
41. "Trends in cardiovascular health metrics in obese adults: National Health and Nutrition Examination Survey (NHANES), 1988-2014". J Am Heart Assoc 2016;5:7: https://doi.org/10.1161/JAHA.116.003619.
42. "Trends in mortality from all causes and cardiovascular disease among hypertensive and nonhypertensive adults in the United States". Circulation 2011;123:16: 1737-1744. https://doi.org/10.1161/CIRCULATIONAHA.110.005645.
43. "Using self-reports or claims to assess disease prevalence: it's complicated". Med Care 2017;55:8: 782-788. https://doi.org/10.1097/MLR.0000000000000753.
