Generally I focus on research related to the health system, but every now and then something directly related to medical care catches my eye. One such piece is a recent study on geographic variation in cardiovascular disease mortality. (JAMA Article) The article covers the period from 1980 to 2014 and looks at death rates by county. During this period cardiovascular disease was the leading cause of death in the United States, although the rate declined precipitously, from 507 deaths per 100,000 persons in 1980 to 253 deaths per 100,000 in 2014. That is a remarkable testament to medical advances, but also helps explain exploding health spending, as all those people who keep living have ongoing medical costs. The variation in mortality across counties is significant, even astounding, but narrowed during the study period, but counties with high death rates from coronary artery disease, for example, have twice the rate of counties with a low incidence. Death rates from cardiovascular disease declined during the study period in all but two US counties.
The bigger picture geographic pattern of heart disease deaths shows much higher rates in the lower Mississippi River Valley, southeastern Oklahoma and eastern Kentucky. Areas with lower incidence included the San Francisco area, central Colorado, northern Nebraska, southern Florida, central Minnesota and northeastern Virginia. Specific cardiovascular disease had different clustering, for example atrial fibrillation in the Northeast and aortic aneurysm in the Midwest. So now you know where to move to! It is interesting to wonder if the correlation is just with poverty or is there literally something in the water or environment? How much has to do with variations in medical practice and compliance with recommended preventative measures? Lack of access to certain health resources? Looking at the maps and graphs is fascinating and certainly gives policymakers further information on where to target efforts to reduce heart disease.
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at 
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