Pervasive Stagnation: Flat and Rising Cardiovascular Disease Mortality Post-2010 Across US States and Counties.

Since 2010, the U.S. has experienced adverse trends in cardiovascular disease (CVD) mortality, which dramatically slowed long-standing life expectancy improvements. The extent to which the national trend in CVD mortality masks heterogeneity in trends across states and counties is poorly understood. We provide a detailed accounting of post-2010 trends in CVD mortality by U.S. state and county to understand how features of place relate to trends. We compare trends during 2010-2019 to that of 2000-2009. We observe flattening declines in CVD mortality in nearly every state at both midlife (ages 40-64) and old age (ages 65-84) across the two decades. Many states exhibited increases in midlife CVD mortality in 2010-2019. Old age CVD mortality was still declining in most states post-2010, although much slower compared to the previous decade. States in the Southeast recorded some of the fastest post-2010 declines in CVD mortality at old age. County-level median household income was associated with level of CVD mortality, but all income deciles, even the wealthiest counties, experienced stagnating CVD mortality declines. Findings highlight the ubiquitous nature of CVD stagnation, pointing to the need to identify risk factor affecting trends across regions and socioeconomic strata across the United States.