Background: Cardiovascular disease (CVD) remains the leading cause of death and an important contributor to US health disparities.
Objectives: To assess county-level CVD mortality and trends by race and/or ethnicity, and by detailed CVD cause of death.
Methods: We estimated age-standardized mortality rates (ASMR) for 5 racial and/or ethnic groups (American Indian or Alaska Native [AIAN], Asian or Pacific Islander [Asian], Black or African American [Black], Latino or Hispanic [Latino], and White), 3110 counties, 21 causes of CVD death, and 20 years (2000-2019) using small-area estimation methods and death certificate data from the US National Vital Statistics System. Estimated mortality rates were adjusted for misreporting of race and/or ethnicity on death certificates and age-standardized to the 2010 census. Counties were classified into persistently high-mortality, persistently low-mortality, and intermediate strata based on age-adjusted CVD mortality rates, stratified by race and ethnicity.
Results: ASMR for total CVD was 237.8 (95% uncertainty interval: 237.2-238.4) deaths per 100,000 in 2019. Mortality was highest for the Black population for total CVD and 12 of 17 detailed CVD causes, and lowest for the Asian population for total CVD and 13 of 17 detailed causes. From 2000 to 2019, mortality declined for total CVD and 12 of 17 detailed causes; however, mortality increased for three detailed causes. Mortality also varied widely among counties-much more than among states-both within and among racial and/or ethnic populations. Spatial mortality patterns varied considerably by CVD cause and by race and/or ethnicity.
Conclusions: While declining CVD mortality reflects meaningful clinical and public health progress, persistent and pervasive disparities demand solutions-oriented, place-informed research to drive further progress. Critically, these pre-pandemic data establish a baseline essential for isolating pandemic-attributable shifts from pre-existing trends. These granular, county-level data stratified by CVD cause, race and/or ethnicity offer a scalable, repeatable framework for agencies to tailor health interventions and rigorously track disparities over time.
Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC
CME Editor
Ragavendra R. Baliga, MD
Author
George A. Mensah, MD
Important Dates
Date of Release: November 3, 2026
Term of Approval/Date of CME/MOC Expiration: November 2, 2027