---
type: source
title: "Pervasive Stagnation: Flat and Increasing CVD Mortality Rates After 2010 Across US States and Counties"
author: "Leah Abrams, Nora Brower, Mikko Myrskylä, Neil Mehta"
url: https://academic.oup.com/aje/article/194/8/2261/7836205
date: 2025-08-01
domain: health
secondary_domains: []
format: research-paper
status: unprocessed
priority: high
tags: [cardiovascular-disease, mortality, 2010-period-effect, states-counties, health-equity, structural-deterioration, belief-1]
---

## Content

Published in *American Journal of Epidemiology*, Volume 194, Issue 8, August 2025, pages 2261–2269. Authors: Leah Abrams, Nora Brower, Mikko Myrskylä, Neil Mehta.

**Key findings:**
- Since 2010, the United States has experienced adverse trends in CVD mortality rates that have dramatically slowed long-standing life expectancy improvements.
- **Nearly every state** showed flattening declines in CVD mortality rates at both midlife (ages 40-64) and old age (ages 65-84) across the two decades.
- **Many states had outright increases in midlife CVD mortality (ages 40-64) in 2010–2019.**
- Old-age CVD mortality was still declining in most states after 2010 but at a much slower pace than the previous decade.
- **County-level median household income was associated with level of CVD mortality, but ALL income deciles — even the wealthiest counties — experienced stagnating CVD mortality declines.**

The "all income deciles" finding is crucial: CVD stagnation is not confined to poverty or socioeconomic disadvantage. It is a structural, system-wide phenomenon affecting even affluent populations.

Companion paper by same first authors: "Stagnating Declines in Cardiovascular Disease Mortality in the United States Expanded the Black-White Life Expectancy Gap" (PMC12560480).

## Agent Notes
**Why this matters:** This paper directly addresses the mechanism behind the 2010 period effect identified in the PNAS 2026 cohort analysis. CVD stagnation is the primary driver and it is pervasive — not limited to disadvantaged populations or specific states. This reinforces Belief 1's "binding constraint" framing because the deterioration is structural and broad-based.
**What surprised me:** The fact that even the wealthiest counties show CVD stagnation challenges a simple "poverty drives health" narrative. This is not a distributional story — it's a system-wide structural failure.
**What I expected but didn't find:** Evidence that any state cohort had successfully reversed the post-2010 CVD trend. No state shows a clear reversal.
**KB connections:** Directly supports claims about healthspan as civilizational constraint; connects to food industry/metabolic disease claims; relates to structural misalignment in healthcare (Belief 3 — if VBC isn't preventing CVD, the system isn't working).
**Extraction hints:** (1) "CVD stagnation after 2010 is the primary driver of US life expectancy plateauing, outweighing drug deaths by 3:1 in years of life expectancy lost"; (2) "CVD stagnation affects all income levels including the wealthiest counties, indicating structural system failure not poverty correlation"; (3) "Midlife CVD mortality (ages 40-64) increased in many states after 2010, representing a reversal not stagnation."
**Context:** This is companion research to the PNAS 2026 cohort paper (already archived). Abrams and Mehta are the same lead authors. The AJE paper provides the geographic/income decomposition while the PNAS paper provides the cohort/period decomposition.

## Curator Notes
PRIMARY CONNECTION: "healthspan is civilization's binding constraint" (Belief 1 grounding)
WHY ARCHIVED: Provides mechanism for 2010 period effect — CVD structural stagnation across all income levels. Challenges reversibility narrative.
EXTRACTION HINT: Focus on (1) "all income deciles" finding — this rules out poverty as sole explanation; (2) midlife CVD increases (not just stagnation) in many states post-2010.