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Abstract：
Background Over the past two decades, there have been numerous advances in acute myocardial infarction (AMI) care. We assessed the impact of these advances on the trend of AMI-related mortality. Methods This retrospective analysis of the Centers for Disease Control\'s Wide-ranging Online Data for Epidemiologic Research (CDC_WONDER) database focused on AMI-related mortality in individuals aged 65 and older in the United States from 1999 to 2020. Trends -n crude and age-adjusted mortality rates (AAMR) were assessed based on socio-demographic and regional variables using Joinpoint Regression software (Joinpoint Regression Program, Version 5.0.2 - May 2023; Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute Bethesda, Maryland). Annual percentage change (APC) with 95% confidence intervals (CIs) for the AAMRs were calculated for the line segments linking a Joinpoint using a data-driven weighted Bayesian Information Criterion (BIC) model. Results There were 2,354,971 AMI-related deaths with an overall decline in the AAMR from 474.6 in 1999 to 153.2 in 2020 and an average annual percentage change (AAPC) of -5.3 (95% CI -5.4 to -5.2). Notable declines were observed across gender, race, age groups, and urbanization levels. However, the rate of AMI-related deaths at decedents\' homes slowed down between 2008 and 2020 and climbed up between 2018 and 2020. In addition to this, nonmetropolitan areas were found to have a significantly lower decline in mortality when compared to large and medium/small metropolitan areas. Conclusion While there is an overall positive trend in reducing AMI-associated mortality, disparities persist, emphasizing the need for targeted interventions.
摘要：
背景在过去的二十年里，在急性心肌梗死(AMI)治疗方面取得了许多进展.我们评估了这些进展对AMI相关死亡率趋势的影响。方法回顾性分析疾病控制中心的广泛在线流行病学研究数据（CDC_WONDER）数据库，重点是1999年至2020年美国65岁及以上人群与AMI相关的死亡率。趋势-n粗和年龄调整后的死亡率（AAMR）基于社会人口统计学和区域变量，使用JoinpointRegression软件（JoinpointRegressionProgram，5.0.2版-2023年5月；统计方法和应用部门，监测研究计划，国家癌症研究所贝塞斯达，马里兰)。使用数据驱动的加权贝叶斯信息标准（BIC）模型，为连接接合点的线段计算了AAMR的95％置信区间（CI）的年度百分比变化（APC）。结果有2,354,971例AMI相关死亡，AAMR从1999年的474.6下降到2020年的153.2，平均年变化百分比（AAPC）为-5.3（95％CI-5.4至-5.2）。在不同性别之间观察到显著的下降，种族,年龄组,和城市化水平。然而,死者家庭与AMI相关的死亡率在2008年至2020年期间放缓，在2018年至2020年期间上升。除此之外,与大、中/小大都市地区相比,非大都市地区的死亡率下降幅度明显较低.结论虽然在降低AMI相关死亡率方面存在总体积极趋势,差距仍然存在，强调需要有针对性的干预措施。
