Historic and recent trends in county-level coronary heart disease death rates by race, gender, and age group, United States, 1979-2017

Adam S. Vaughan; Linda Schieb; Michele Casper

doi:10.1371/journal.pone.0235839

Peer Review History

Original SubmissionFebruary 20, 2020
15 Apr 2020 Decision Letter - Katriina Aalto-Setala, Editor PONE-D-20-04975 Historic and recent trends in county-level coronary heart disease death rates by race, gender, and age group, United States, 1979-2017 PLOS ONE Dear Dr Adam Vaughan, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We were very happy to read your article. There are, however, some issues the reviewers need you to clarify/add before the manuscript can be accepted to be published. We would appreciate receiving your revised manuscript by May 30 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The following reflects a biostatistical review of the manuscript. In this work, the authors perform a thorough examination of geographic variation in coronary heart disease (CHD) mortality, and in temporal trends for CHD mortality. They used a Bayesian multivariate space-time autoregressive model, allowing for "borrowing strength" in estimation, for neighboring counties, years, and demographic groups. Specifically, a strength of this method is that it allows for stable estimation of rates and trends even in years/ages/counties/demographic groups with very few observations. The authors identified significant spatiotemporal variation in CHD rates. In particular, they identified counties with recent increases in CHD mortality, going against the overall national trend of CHD mortality reduction. While this manuscript is excellent overall, I believe it would benefit from some relatively minor changes. In particular, since the modeling is such a critical part of the work, it would greatly strengthen the manuscript to include a more detailed description of the model details. The results are difficult to interpret without the context of the model details, and it is appropriate to include those details within this manuscript rather than requiring the reader to look elsewhere. The methods section (line 71) states that the model is able to borrow strength across adjacent demographic groups. How is adjacency defined in this context? Aside from adjacency between age groups, adjacency relationships (and the strength of these relationships) between demographic groups are not obvious. Please include details on this in the methods section. How were the four intervals (1979-1990, 1990-2000, 2000-2010, 2010-2017) chosen for the APC calculations? Reviewer #2: Vaughan et al examined the trends of county-level death rates due to coronary heart disease in the US from 1797 to 2017. My comments are listed below: 1. Line 65: in this section it is not clear whether the death rates were crude rates or standardized/adjusted rates. From the tables presented it seems that the rates were age standardized. If this is the case, please specify it in the methods. 2. Line 77: Please provide rationale for only including death at age 35 and above? And the reason of categorizing age groups as 35-64, ages 65 and older? 3. Line 233-238: The authors should consider the possibility of changes in the validity of death certificate coding during the study period. With greater focus on population levels of blood pressure its plausible that the validity of codes assigning cause of death to coronary heart disease may have not been stable over this time period. And how this can affect the results. Reviewer #3: This is a well-written, important manuscript that provides key data on changes in CHD mortality rates in the US over time. There are additional analyses/considerations that could strengthen the findings of this paper. 1. In the introduction, there is no acknowledgement of work on premature CVD mortality as recently published by Chen and colleagues (JAMA Cardiology doi:10.1001/jamacardio.2019.3891). This work should be cited and briefly described. 2. Why were those aged 35-64 combined into one group? CHD events before age 50 may be different from those after age 50 (could be more related to genetic susceptibility). Were there considerations about dividing up the groups 35-49 vs. 50-64 vs. 65+? ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0235839.r001
Revision 1
11 May 2020 Author Response Thank you for the thorough review of this paper. Our responses to each comment are presented below. Reviewer #1: The following reflects a biostatistical review of the manuscript. In this work, the authors perform a thorough examination of geographic variation in coronary heart disease (CHD) mortality, and in temporal trends for CHD mortality. They used a Bayesian multivariate space-time autoregressive model, allowing for "borrowing strength" in estimation, for neighboring counties, years, and demographic groups. Specifically, a strength of this method is that it allows for stable estimation of rates and trends even in years/ages/counties/demographic groups with very few observations. The authors identified significant spatiotemporal variation in CHD rates. In particular, they identified counties with recent increases in CHD mortality, going against the overall national trend of CHD mortality reduction. While this manuscript is excellent overall, I believe it would benefit from some relatively minor changes. In particular, since the modeling is such a critical part of the work, it would greatly strengthen the manuscript to include a more detailed description of the model details. The results are difficult to interpret without the context of the model details, and it is appropriate to include those details within this manuscript rather than requiring the reader to look elsewhere. Response: We have modified the methods (page 5) to include much greater detail about the model. The methods section (line 71) states that the model is able to borrow strength across adjacent demographic groups. How is adjacency defined in this context? Aside from adjacency between age groups, adjacency relationships (and the strength of these relationships) between demographic groups are not obvious. Please include details on this in the methods section. Response: We have included these details in the methods (page 5). How were the four intervals (1979-1990, 1990-2000, 2000-2010, 2010-2017) chosen for the APC calculations? Response: We have included a description of how those intervals were chosen in the methods (line 108). Reviewer #2: Vaughan et al examined the trends of county-level death rates due to coronary heart disease in the US from 1797 to 2017. My comments are listed below: 1. Line 65: in this section it is not clear whether the death rates were crude rates or standardized/adjusted rates. From the tables presented it seems that the rates were age standardized. If this is the case, please specify it in the methods. Response: All death rates were age-standardized using the 2000 US standard population. This was previously included in the manuscript (line 83), so no change has been made. 2. Line 77: Please provide rationale for only including death at age 35 and above? And the reason of categorizing age groups as 35-64, ages 65 and older? Response: Deaths were only included for ages 35 and older because deaths from CHD below age 35 are exceedingly rare. Including these deaths would therefore add to the denominator but not the numerator, lowering death rates in this middle-aged group. We selected these two age groups based on both past work and on public health programs. Our prior work found that ages 35-64 have experienced widespread increases in death rates due to cardiovascular disease, but these death rates have continued to decline for ages 65 and older. Additionally, national initiatives such as Million Hearts include adults ages 35-64 as a target population. Our inclusion of this age group in this paper therefore directly informs public health practice. We have clarified this in the introduction (line 47) and in the methods (line 70). 3. Line 233-238: The authors should consider the possibility of changes in the validity of death certificate coding during the study period. With greater focus on population levels of blood pressure its plausible that the validity of codes assigning cause of death to coronary heart disease may have not been stable over this time period. And how this can affect the results. Response: We have included this as a limitation (line 263). Reviewer #3: This is a well-written, important manuscript that provides key data on changes in CHD mortality rates in the US over time. There are additional analyses/considerations that could strengthen the findings of this paper. 1. In the introduction, there is no acknowledgement of work on premature CVD mortality as recently published by Chen and colleagues (JAMA Cardiology doi:10.1001/jamacardio.2019.3891). This work should be cited and briefly described. Response: Thank you for pointing out this key reference. We have included this reference and its context in the introduction (line 42). 2. Why were those aged 35-64 combined into one group? CHD events before age 50 may be different from those after age 50 (could be more related to genetic susceptibility). Were there considerations about dividing up the groups 35-49 vs. 50-64 vs. 65+? Response: Deaths were only included for ages 35 and older because deaths from CHD below age 35 are exceedingly rare. Including these deaths would therefore add to the denominator but not the numerator, lowering death rates in this middle-aged group. We selected these two age groups based on both past work and on public health programs. Our prior work found that ages 35-64 have experienced widespread increases in death rates due to cardiovascular disease, but these death rates have continued to decline for ages 65 and older. Additionally, national initiatives such as Million Hearts include adults ages 35-64 as a target population. Our inclusion of this age group in this paper therefore directly informs public health practice. We have clarified this in the introduction (line 47) and in the methods (line 70). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0235839.r002
24 Jun 2020 Decision Letter - Katriina Aalto-Setala, Editor Historic and recent trends in county-level coronary heart disease death rates by race, gender, and age group, United States, 1979-2017 PONE-D-20-04975R1 Dear Dr. Vaughan, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Katriina Aalto-Setala, Professor Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: (No Response) Reviewer #3: All comments have been addressed adequately. There are no further comments at this time. The authors have also addressed the questions regarding the statistical methods. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No https://doi.org/10.1371/journal.pone.0235839.r003
Formally Accepted
25 Jun 2020 Acceptance Letter - Katriina Aalto-Setala, Editor PONE-D-20-04975R1 Historic and recent trends in county-level coronary heart disease death rates by race, gender, and age group, United States, 1979-2017 Dear Dr. Vaughan: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr Katriina Aalto-Setala Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0235839.r004

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