It’s a testament to modern medicine that death rates from heart disease around the nation have been cut in half, yet new research sheds light on the wide disparities in cardiovascular death rates depending on geography. Using death certificate data, a research group led by University of Washington Medical Center cardiologist Dr. Gregory Roth conducted the most comprehensive analysis of deaths due to cardiovascular diseases in history.

Their findings indicated that cardiovascular death rates have been cut in half since 1980, though cardiovascular disease still represents the cause of death in the United States. In 2014, for instance, cardiovascular diseases accounted for more than 846,000 deaths, according to the research, which was published in the Journal of the American Medical Association.

But death rates can vary widely: for example, cardiovascular death rates are twice as high in Richmond, Martin and Columbus counties as they are in Chatham County. “This kind of variation occurs on a really small geographic level. So even from one county to the next we see these huge gaps in health related to heart disease,” said Roth. “We clear see higher rates of cardiovascular deaths in places that are poor, and we know that health care quality is worse in locations with lower incomes and lower levels of education.”

Moreover, there are early warning signs. Across the state and nation, cardiovascular death rates have begun to creep up again. “Cardiovascular disease is down on average in the United States, but the rate that it’s been going down has really flattened and in the last year or two we’ve seen very little decline at all. And in some states and counties we are actually seeing it go up again for the first time in 50 years,” said Roth.

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