Heart Disease and Stroke Statistics—2008 Update
2007; Lippincott Williams & Wilkins; Volume: 117; Issue: 4 Linguagem: Inglês
10.1161/circulationaha.107.187998
ISSN1524-4539
AutoresWayne D. Rosamond, Katherine M. Flegal, Karen L. Furie, Alan S. Go, Kurt J. Greenlund, Nancy Haase, Susan M. Hailpern, Michael Ho, Virginia J. Howard, Brett Kissela, Steven J. Kittner, Donald M. Lloyd‐Jones, Mary Mcdermott, James B. Meigs, Claudia S. Moy, Graham Nichol, Christopher O’Donnell, Véronique L. Roger, Paul D. Sorlie, Julia Steinberger, Thomas Thom, M.G.F. Wilson, Yuling Hong,
Tópico(s)Cardiovascular Function and Risk Factors
ResumoHomeCirculationVol. 117, No. 4Heart Disease and Stroke Statistics—2008 Update Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBHeart Disease and Stroke Statistics—2008 UpdateA Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Writing Group Members Wayne Rosamond, Katherine Flegal, Karen Furie, Alan Go, Kurt Greenlund, Nancy Haase, Susan M. Hailpern, Michael Ho, Virginia Howard, Bret Kissela, Steven Kittner, Donald Lloyd-Jones, Mary McDermott, James Meigs, Claudia Moy, Graham Nichol, Christopher O’Donnell, Veronique Roger, Paul Sorlie, Julia Steinberger, Thomas Thom, Matt Wilson, Yuling Hong and Writing Group Members Search for more papers by this author , Wayne RosamondWayne Rosamond Search for more papers by this author , Katherine FlegalKatherine Flegal Search for more papers by this author , Karen FurieKaren Furie Search for more papers by this author , Alan GoAlan Go Search for more papers by this author , Kurt GreenlundKurt Greenlund Search for more papers by this author , Nancy HaaseNancy Haase Search for more papers by this author , Susan M. HailpernSusan M. Hailpern Search for more papers by this author , Michael HoMichael Ho Search for more papers by this author , Virginia HowardVirginia Howard Search for more papers by this author , Bret KisselaBret Kissela Search for more papers by this author , Steven KittnerSteven Kittner Search for more papers by this author , Donald Lloyd-JonesDonald Lloyd-Jones Search for more papers by this author , Mary McDermottMary McDermott Search for more papers by this author , James MeigsJames Meigs Search for more papers by this author , Claudia MoyClaudia Moy Search for more papers by this author , Graham NicholGraham Nichol Search for more papers by this author , Christopher O’DonnellChristopher O’Donnell Search for more papers by this author , Veronique RogerVeronique Roger Search for more papers by this author , Paul SorliePaul Sorlie Search for more papers by this author , Julia SteinbergerJulia Steinberger Search for more papers by this author , Thomas ThomThomas Thom Search for more papers by this author , Matt WilsonMatt Wilson Search for more papers by this author , Yuling HongYuling Hong Search for more papers by this author and Search for more papers by this author and for the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Originally published17 Dec 2007https://doi.org/10.1161/CIRCULATIONAHA.107.187998Circulation. 2008;117:e25–e146is corrected byCorrectionOther version(s) of this articleYou are viewing the most recent version of this article. Previous versions: December 17, 2007: Previous Version 1 Table of ContentsSummary…e261. About These Statistics…e282. Cardiovascular Diseases…e313. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris…e504. Stroke…e615. High Blood Pressure…e766. Congenital Cardiovascular Defects…e827. Heart Failure…e868. Other Cardiovascular Diseases…e90 — Arrhythmias (Disorders of Heart Rhythm)…e90 — Arteries, Diseases of (Including Peripheral Arterial Disease)…e91 — Bacterial Endocarditis…e92 — Cardiomyopathy…e93 — Rheumatic Fever/Rheumatic Heart Disease…e93 — Valvular Heart Disease…e93 — Venous Thromboembolism…e939. Risk Factor: Smoking/Tobacco Use…e9710. Risk Factor: High Blood Cholesterol and Other Lipids…e10211. Risk Factor: Physical Inactivity…e10612. Risk Factor: Overweight and Obesity…e10913. Risk Factor: Diabetes Mellitus…e11314. End-Stage Renal Disease and Chronic Kidney Disease…e12015. Metabolic Syndrome…e12316. Nutrition…e12517. Quality of Care…e12818. Medical Procedures…e13319. Economic Cost of Cardiovascular Diseases…e13720. At-a-Glance Summary Tables…e139 — Males and Cardiovascular Diseases…e139 — Females and Cardiovascular Diseases…e140 — Ethnic Groups and Cardiovascular Diseases…e141 — Children, Youth, and Cardiovascular Diseases…e14221. Glossary …e143Disclosures…e146Appendix I: List of Statistical Fact Sheets. URL: http://www.americanheart.org/presenter.jhtml?identifier=2007We thank Drs Robert Adams, Gary Friday, Philip Gorelick, and Sylvia Wasserthiel-Smoller, members of Stroke Statistics Subcommittee; Drs Joe Broderick, Brian Eigel, Kimberlee Gauveau, Jane Khoury, Jerry Potts, Jane Newburger, and Kathryn Taubert; and Sean Coady and Michael Wolz for their valuable comments and contributions. We acknowledge Tim Anderson and Tom Schneider for their editorial contributions and Karen Modesitt for her administrative assistance.Writing Group DisclosuresWriting Group MemberEmploymentResearch GrantOther Research SupportSpeakers’ Bureau/HonorariaOwnership InterestConsultant/Advisory BoardOtherThis table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (1) the person receives $10 000 or more during any 12-month period, or 5% or more of the person’s gross income; or (2) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition.*Modest.†Significant.Wayne RosamondUniversity of North CarolinaNoneNoneNoneNoneNoneNoneKatherine FlegalCenters for Disease Control and PreventionNoneNoneNoneNoneNoneNoneKaren FurieMassachusetts General HospitalPfizer; Boehringer Ingleheim; National Institute of Neurological Disorders and StrokeNoneGE HealthcareNonePfizerNoneAlan GoNoneAmgen†; Aviir†NoneNoneNoneNoneNoneKurt GreenlundCenters for Disease Control and PreventionNoneNoneNoneNoneNoneNoneNancy HaaseAmerican Heart AssociationNoneNoneNoneNoneNoneNoneSusan M. HailpernConsultantNoneNoneNoneNoneNoneNoneMichael HoVeterans Health AdministrationVA Health Services Research and Development Career Development Award; Colorado Department of Public Health and Environment; American Heart Association Scientist Development GrantNoneNovartis*NoneNoneNoneYuling HongAmerican Heart AssociationNoneNoneNoneNoneNoneNoneVirginia HowardUniversity of Alabama at BirminghamNational Institutes of Health†; National Institute of Neurological Disorders and Stroke†NoneNoneNoneNoneNoneBrett KisselaUniversity of CincinnatiNoneNoneNoneNoneNoneNoneSteven KittnerVeterans Health Administration, University of Maryland School of MedicineNational Institutes of Health; National Institute of Neurological Disorders and Stroke; American Heart Association; Veterans Administration Research GroupNoneNoneNoneNoneNoneDonald Lloyd-JonesNorthwestern University Feinberg School of MedicineNoneNonePfizer*; Merck*NonePfizer*NoneMary McDermottNorthwestern University Feinberg School of MedicineNational Institute of Aging†; National Heart, Lung, and Blood Institute†NoneBristol Myers Squibb,* Sanofi*NoneBristol Myers Squibb*; Sanofi*NoneJames MeigsNoneNIDDK†; GlaxoSmithKline†; sanofi-aventis†NoneNoneNonesanofi-aventis†; Interleukin Genetics*NoneClaudia MoyNational Institutes of HealthNoneNoneNoneNoneNoneNoneGraham NicholUniversity of WashingtonNational Heart, Lung, and Blood Institute; CIHR; MedtronicNoneNoneNoneMedic One Foundation; Northfield LaboratoriesNoneChristopher O’DonnellNational Heart, Lung, and Blood InstituteNoneNoneNoneNoneNoneNoneVeronique RogerMayo ClinicNoneNoneNoneNoneNoneNonePaul SorlieNational Heart, Lung, and Blood InstituteNoneNoneNoneNoneNoneNoneJulia SteinbergerUniversity of MinnesotaNoneNoneNoneNone3M; Abbott LaboratoriesNoneThomas ThomNational Heart, Lung, and Blood InstituteNoneNoneNoneNoneNoneNoneMatt WilsonUniversity of RochesterNoneNoneNoneNoneNoneNonecirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinscirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinsSummary290120081. About These Statistics290120082. Cardiovascular Diseases290120083. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris290120084. Stroke290120085. High Blood Pressure290120086. Congenital Cardiovascular Defects290120087. Heart Failure290120088. Other Cardiovascular Diseases290120089. Risk Factor: Smoking/Tobacco Use2901200810. Risk Factor: High Blood Cholesterol and Other Lipids2901200811. Risk Factor: Physical Inactivity2901200812. Risk Factor: Overweight and Obesity2901200813. Risk Factor: Diabetes Mellitus2901200814. End-Stage Renal Disease and Chronic Kidney Disease2901200815. Metabolic Syndrome2901200816. Nutrition2901200817. Quality of Care2901200818. Medical Procedures2901200819. Economic Cost of Cardiovascular Diseases2901200820. At-a-Glance Summary Tables2901200821. Glossary29012008Each year the American Heart Association, in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media, the lay public, and many others who seek the best national data available on disease and risk factor prevalence, disease incidence, and mortality rates in a single document. This year’s edition includes several areas not covered in previous editions. Below are a few highlights from this year’s Update in the areas of cardiovascular disease (CVD) mortality, control of risk factors, kidney disease, and medical care.Death rates from CVD have declined, yet the burden of disease remains high.The 2004 overall death rate from CVD (International Classification of Diseases 10, I00–I99) was 288.0 per 100 000. The rates were 335.1 per 100 000 for white males, 454.0 per 100 000 for black males, 238.0 per 100 000 for white females, and 333.6 per 100 000 for black females. From 1994 to 2004, death rates from CVD (International Classification of Diseases 10, I00–I99) declined 24.7%. Preliminary mortality data from 2005 show that CVD (I00–I99; Q20–Q28) accounted for 35.2% (861 826) of all 2 447 910 deaths in 2005, or 1 of every 2.8 deaths in the United States.Nearly 2400 Americans die of CVD each day—an average of 1 death every 37 seconds. The 2005 overall preliminary death rate from CVD was 279.2. More than 148 000 Americans killed by CVD (I00–I99) in 2004 were <65 years of age. In 2004, 32% of deaths from CVD occurred before the age of 75 years, which is well before the average life expectancy of 77.9 years.Coronary heart disease caused 1 of every 5 deaths in the United States in 2004. Coronary heart disease mortality was 451 326. In 2008, an estimated 770 000 Americans will have a new coronary attack, and about 430 000 will have a recurrent attack. It is estimated that an additional 175 000 silent first myocardial infarctions occur each year. About every 26 seconds, an American will have a coronary event, and about every minute someone will die from one.Each year, about 780 000 people experience a new or recurrent stroke. About 600 000 of these are first attacks, and 180 000 are recurrent attacks. Preliminary data from 2005 indicate that stroke accounted for about 1 of every 17 deaths in the United States. On average, every 40 seconds someone in the United States has a stroke. From 1994 to 2004, the stroke death rate fell 24.2%, and the actual number of stroke deaths declined 6.8%.In 2004, 1 in 8 death certificates (284 365 deaths) in the United States mentions heart failure.Control of risk factors remains an issue for many Americans.The age-adjusted prevalence of high low-density lipoprotein cholesterol in US adults was 26.6% in 1988–1994 and 25.3% in 1999–2004. Between 1988–1994 and 1999–2004, awareness increased from 39.2% to 63.0%, and use of pharmacological lipid-lowering treatment increased from 11.7% to 40.8%. Low-density lipoprotein cholesterol control increased from 4.0% to 25.1% among those with high low-density lipoprotein cholesterol.Overall, 62.0% of adults ≥18 years of age engaged in at least some vigorous and/or light-moderate leisure-time physical activity lasting ≥10 minutes per session. In 2002–2004, 40.2% of people ≥75 years of age (age adjusted) engaged in at least some regular leisure-time physical activity. Men were more likely (64.0%) to exercise than were women (60.2%).More than 9 million children and adolescents between 6 and 19 years of age are considered overweight on the basis of being in the 95th percentile or higher of body mass index values in the 2000 Centers for Disease Control and Prevention growth chart.On the basis of data from the National Health and Nutrition Examination Survey, the prevalence of overweight in children between 6 and 11 years of age increased from 4.0% in 1971–1974 to 17.5% in 2001–2004. The prevalence of overweight in adolescents between 12 and 19 years of age increased from 6.1% to 17.0%. In 2003–2004, 36% of women 65 to 74 years of age and 24% of women ≥75 years of age were obese. This is an increase from 1988–1994, when 27% of women 65 to 74 years of age and 19% of women ≥75 years of age were obese. For men, from 1988–1994, 24% of those 65 to 74 years of age and 13% of those ≥75 years of age were obese, compared with 33% of those 65 to 74 years of age and 23% of those ≥75 years of age in 2003–2004.One and a half million new cases of diabetes were diagnosed in people ≥20 years of age in 2005.The 2008 Update expands data coverage of CVD-related kidney disease.End-stage renal disease and chronic kidney disease are conditions that are most commonly associated with diabetes and/or high blood pressure and occur when the kidneys can no longer function normally on their own.The incidence of reported end-stage renal disease has almost doubled in the past 10 years. In 2004, 104 364 new cases of end-stage renal disease were reported.The number of persons treated for end-stage renal disease increased from 68 757 in 1994 to 102 356 in 2004; this translates to 261.3 per million in 1994 to 348.6 per million in 2004.The US Renal Data System estimates that by 2010, 650 000 Americans will require treatment for kidney failure, which represents a 60% increase over the number who received such treatment in 2001.The prevalence of chronic kidney disease (stages I–V) is 16.8%. This represents an increase over the 14.5% prevalence estimate from the National Health and Nutrition Examination Survey 1988–1994.The prevalence of chronic kidney disease was greater among those with diabetes (40.2%), hypertension (24.6%), and CVD (28.2%) than among those without these chronic conditions.Improvements in medical care are being made.Over a 3-year period from 2002 through 2004, among 159 168 patients admitted with heart failure at 285 hospitals, inotrope use decreased, and improvements were made in providing discharge instructions, smoking counseling, left ventricular assessment, and β-blocker prescription.During this same period of time, clinical outcomes improved, including the need for mechanical ventilation (5.3% to 3.4%), length of stay (mean, 6.3 days to 5.5 days), and in-hospital death rate (4.5% to 3.2%).The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current data available in the Statistics Update. The 2005 preliminary mortality data have been released, and although not included in this year’s Update, more information can be found at the National Center for Health Statistics Web site, http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimdeaths05/prelimdeaths05.htm.The American Heart Association (AHA) works with the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS); the National Heart, Lung, and Blood Institute (NHLBI); the National Institute of Neurological Disorders and Stroke (NINDS); and other government agencies to derive the annual statistics in this Update. This chapter describes the most important sources and the types of data we use from them. For more details and an alphabetical list of abbreviations, see Chapter 21 of this document, the Glossary and Abbreviation Guide.The surveys used are:Behavioral Risk Factor Surveillance Survey (BRFSS)—ongoing telephone health survey systemGreater Cincinnati/Northern Kentucky Stroke Study (GCNKSS)—stroke incidence rates and outcome within a biracial populationMedical Expenditure Panel Survey (MEPS)—data on specific health services that Americans use, how frequently they use them, the cost of these services, and how they are paid forNational Health and Nutrition Examination Survey (NHANES)—disease and risk factor prevalence and nutrition statisticsNational Health Interview Survey (NHIS)—disease and risk factor prevalenceNational Hospital Discharge Survey (NHDS)—hospital inpatient discharges (discharged alive, dead, or status unknown)National Ambulatory Medical Care Survey (NAMCS)—physician office visitsNational Hospital Ambulatory Medical Care Survey (NHAMCS)—hospital outpatient and emergency department visitsNational Inpatient Sample (NIS) of the Agency for Health Research and Quality—hospital inpatient discharges and chargesNational Institute of Neurological Disorders and Stroke (NINDS)—brain and nervous system disordersNational Nursing Home Survey (NNHS)—nursing home visitsNational Vital Statistics—national and state mortality dataWorld Health Organization (WHO)—country mortalityYouth Risk Behavior Surveillance (YRBS)—trends for 6 categories of priority health-risk behaviors in youth and young adultsDisease PrevalencePrevalence is an estimate of how many people have a disease at a given point or period in time. The NCHS conducts health examination and health interview surveys that provide estimates of the prevalence of diseases and risk factors. In this Update, the health interview part of the NHANES is used for the prevalence of cardiovascular diseases (CVD). NHANES is used more than the NHIS because in NHANES, angina pectoris (AP) is based on the Rose Questionnaire; estimates are made regularly for heart failure (HF); hypertension is based on blood pressure (BP) measurements and interviews; and an estimate can be made of total CVD to include myocardial infarction (MI), AP, HF, stroke, and hypertension.A major emphasis of this Update is to present the latest estimates of the number of persons in the United States who have specific conditions in order to provide a more realistic estimate of burden. Most estimates based on NHANES prevalence rates use data collected from 1999 to 2004 (in most cases, these are the latest published figures). These are applied to census population estimates for 2005. Differences in population estimates based on extrapolations of rates beyond the data collection period by using more recent census population estimates cannot be used to evaluate possible trends in prevalence. Trends can only be evaluated by comparing prevalence rates estimated from surveys conducted in different years.Risk Factor PrevalenceThe NHANES 1999–2004 data are used in this Update to present estimates of the percentage of persons with high lipid values, diabetes, overweight, and obesity. The NHIS is used for the prevalence of cigarette smoking and physical inactivity. Data for students in grades 9 through 12 are obtained from the Youth Risk Factor Surveillance System.Incidence and Recurrent AttacksAn incidence rate refers to the number of new cases of a disease that develop in a population per unit of time. The unit of time is not necessarily 1 year, although we often discuss incidence in terms of 1 year. For some statistics, new and recurrent attacks or cases are combined. Our national incidence estimates for the various types of CVD are extrapolations to the US population from the Framingham Heart Study (FHS), the Atherosclerosis Risk in Communities (ARIC) study, the Cardiovascular Health Study (CHS) conducted by the NHLBI, and the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) funded by the NINDS. The rates change only when new data are available; they are not computed annually. Do not compare the incidence or the rates with those in past editions of the Heart and Stroke Statistical Update (renamed the Heart Disease and Stroke Statistics Update). Doing so can lead to serious misinterpretation of time trends.MortalityMortality data are grouped according to the underlying cause of death. “Total-mention” mortality is the number of death certificates in 2004 that mention the given disease classification either as the underlying cause or as a contributing cause. These were final 2004 data unless otherwise indicated. For many deaths classified as attributable to CVD, selection of the most likely single underlying cause can be difficult when several major comorbidities are present, as is often the case in the elderly population. It is, therefore, useful to know the extent of mortality from a given cause, regardless of whether it is the underlying cause or a contributing cause—ie, its “total mentions.” In all comparisons of deaths and death rates between 1994 and 2004, 1994 data were modified using appropriate comparability ratios.The first text section for each disease listed in this Update mentions mortality information. This includes the number of deaths for which the disease is the underlying cause; this is referred to as “mortality.” That number is followed by “total-mention mortality.” All other numbers or rates of deaths in the Update refer to the given disease as the underlying cause. The one exception, heart failure, is explained in that section.National and state mortality data presented according to the underlying cause of death are computed from the Data Warehouse mortality tables of the NCHS Web site or the compressed CDC file. Total-mention numbers of deaths are tabulated from the electronic mortality files of the NCHS Web site.Population EstimatesIn this publication, we have used national population estimates from the US Census Bureau for 2005 in the computation of morbidity data. Data for 2004 are used in the computation of death rates. The Census Bureau Web site contains these data as well as information on the file layout.1Hospital Discharges and Ambulatory Care VisitsEstimates of the numbers of hospital discharges and numbers of procedures performed are for inpatients discharged from short-stay hospitals. Discharges include those discharged alive, dead, or with unknown status. Unless otherwise specified, discharges are according to the first-listed (primary) diagnosis, and procedures are listed according to the all-listed diagnosis (primary plus secondary). These estimates are from the NHDS of the NCHS unless otherwise noted. Ambulatory care visits include patient visits to hospital emergency or outpatient departments and to physicians’ offices.International Classification of DiseasesMorbidity (illness) and mortality (death) data in the United States use a standard classification system: the International Classification of Diseases (ICD). About every 10 to 20 years, the ICD codes are revised to reflect changes over time in medical technology, diagnosis, or terminology. Where necessary for comparability of mortality trends across the 9th and 10th ICD revisions, comparability ratios computed by NCHS are applied as noted.2 Effective with mortality data for 1999, we are using the 10th revision (ICD-10). It will be a few more years before the 10th revision is used for hospital discharge data, which are based on the International Classification of Diseases, Clinical Modification, Ninth Revision (ICD-9-CM).3Age AdjustmentPrevalence and mortality estimates for the United States or individual states comparing demographic groups or estimates over time either are age specific or are age adjusted to the 2000 standard population by the direct method.4 International mortality data are age adjusted to the European standard.5 Unless otherwise stated, all death rates in this publication are age adjusted and are per 100 000 population.Data Years for National EstimatesIn this Update we estimate the annual number of new (incidence) and recurrent cases of a disease in the United States by extrapolating to the US population in 2005 from rates reported in a community- or hospital-based study or multiple studies. Age-adjusted incidence rates by sex and race are also given in this report as observed in the study or studies. For US mortality, most numbers and rates are for 2004. For disease and risk factor prevalence, most rates in this report are calculated from the 1999–2004 NHANES. Rates by age and sex are also applied to the US population in 2005 to estimate the numbers of persons with the disease or risk factor in that year. Because NHANES is conducted only in the noninstitutionalized population, we extrapolated the rates to the total US population in 2005, recognizing that this probably underestimates total prevalence given the relatively high prevalence in the institutionalized population. The numbers and rates of hospital inpatient discharges for the United States are for 2005, as are many of the numbers of physician office visits and visits to hospital emergency and outpatient departments. Except as noted, economic cost estimates are projected to 2008.Cardiovascular DiseaseFor data on hospitalizations, physician office visits, and mortality, CVD is defined according to ICD codes given in Chapter 21 of the present document. This definition includes all diseases of the circulatory system and congenital CVD. Unless so specified, an estimate for total CVD does not include congenital CVD.RaceData published by governmental agencies for some racial groups are considered unreliable because of the small sample size in the studies. Because we try to provide data for as many racial groups as possible, we show these data for informational and comparative purposes.ContactsIf you have questions about statistics or any points made in this Update, please contact the Biostatistics Program Coordinator at the American Heart Association National Center (e-mail [email protected], phone 214-706-1423). Direct all media inquiries to News Media Relations at [email protected] or 214-706-1173.We do our utmost to ensure that this Update is error free. If we discover errors after publication, we will provide corrections at our Web site, http://www.americanheart.org/statistics, and in the journal Circulation.See the Glossary for an explanation of terms.Abbreviations Used in Chapter 1AHAAmerican Heart AssociationAHRQAgency for Health Research and QualityAPangina pectorisARICAtherosclerosis Risk in Communities studyBPblood pressureBRFSSBehavioral Risk Factor Surveillance SystemCDCCenters for Disease Control and PreventionCHSCardiovascular Health StudyCVDcardiovascular diseaseFHSFramingham Heart StudyGCNKSSGreater Cincinnati/Northern Kentucky Stroke StudyHFheart failureICDInternational Classification of DiseasesMEPSMedical Expenditure Panel SurveyMImyocardial infarctionNAMCSNational Ambulatory Medical Care SurveyNCHSNational Center for Health StatisticsNHAMCSNational Hospital Ambulatory Medical Care SurveyNHANESNational Health and Nutrition Examination SurveyNHDSNational Hospital Discharge SurveyNHISNational Health Interview SurveyNHLBINational Heart, Lung, and Blood InstituteNINDSNational Institute of Neurological Disorders and StrokeNISNational Inpatient SampleNNHSNational Nursing Home SurveyWHOWorld Health OrganizationYRBSYouth Risk Behavior SurveillanceICD-9 390–459, 745–747, ICD-10 I00–I99, Q20–Q28; see Glossary (Chapter 21) for details
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