Stall in Heart Disease Death Rates, Evidence From Maine, 1999-2017

Introduction Since the 1950s, heart disease deaths have declined in the United States, but recent reports indicate a plateau in this decline. Heart disease death rates increased in Maine from 2011-2015. We ex-amined reasons for the trend change in Maine's heart disease death rates, including the contributing types of heart disease. Methods We obtained Maine's annual heart disease death data for 1999-2017 from CDC's Wide-ranging Online Data for Epidemi-ologic Research (CDC WONDER). We used joinpoint regression to determine changes in trend and annual percentage change (APC) in death rates for heart disease overall and by demographic groups, types of heart disease, and geographic area. Results Joinpoint modeling showed that Maine's age-adjusted heart dis-ease death rates decreased during 1999-2010 (-4.2% APC), then plateaued during 2010-2017 (-0.1% APC). Death rates flattened for both sexes and age groups >= 45 years. Although death rates for acute myocardial infarction (AMI) decreased through 2017, hyper-tensive heart disease (HHD) and heart failure death rates in-creased. Death rates attributable to diabetes-related heart disease and non-AMI ischemic heart disease (IHD) plateaued. Conclusion Declines in Maine's heart disease death rates have plateaued, sim-ilar to national trends. Flattening rates appear to be driven by ad-verse trends in HHD, heart failure, diabetes-related heart disease, and non-AMI IHD. Increased efforts to address cardiovascular dis-ease risk factors, chronic heart disease, and access to care are ne-cessary to continue the decrease in heart disease deaths in Maine.