Sex Disparities in Ischemic Heart Disease Mortality Across United States: The Southern Burden of Excess Body Weight and Diet

Background

While prior studies have assessed sex disparities in ischemic heart disease (IHD) outcomes in the United States (US), little is known about how these differences vary across states.

Methods

We analyzed Global Burden of Disease (GBD) data from 2011 to 2021 for all 50 US states. Sex‐specific age‐standardized IHD mortality rates (ASMRs) and age‐standardized IHD prevalence rates (ASPRs) were used to calculate the mortality‐to‐prevalence ratios (MPRs) per 100,000 inhabitants per year, enabling comparison of death rates relative to the population at risk. Hawaii, the state with the lowest ASPR and ASMR in both sexes, served as the reference for Z‐score analyses, with 99% (Z > 2.58) or 95% (Z > 1.96) confidence thresholds.

Results

In 2011, 30 states had significantly higher MPRs in females than males (Z > 2.58), indicating elevated mortality in females with IHD. By 2021, only Arkansas (6.7% [UI: 4.6–9.3]) and Mississippi (7.1% [UI: 4.8–9.7]) exceeded this threshold, while 11 additional states, mainly in the South, retained moderate disparities (Z > 1.96). Higher MPRs were inversely associated with state GDP per capita. High body max index, processed meat intake, low fiber, and low vegetable intake emerged as the most significant contributors (Z > 1.96, 95%) to excess IHD mortality in females but not males.

Conclusions

Despite an overall decline, sex disparities in IHD mortality persist with Arkansas and Mississippi continuing to bear the highest burden. These disparities are largely driven by overweight/obesity and dietary risk factors, warranting targeted, state‐level interventions.