Cardiac death rates vary by a factor of six or more across regions of the US, from very low rates in Arizona, Utah, Washington, about 1/1000/year, to well over 6/1000/year in the US southeast. This is shown in the map below based on CDC data from 2013, mapped by Dr. Robert-J using ArcGIS Pro in 2015, Source here.
The author of this graph humorously(?) overlayed the cardiac death data with yellow dots showing the location of all US waffle houses. I infer from this something that Dr. J. denies: that waffle houses, or waffle eating is a significant contributor to these cardiac deaths. Other possibilities (my own list) include opioids, pollution, low exercise, depression, and poor healthcare. Still, I can’t help thinking that diet is a big contributor.
Here is a more up-to-date map, by county, showing that cardiac deaths still concentrate in the southeast, but now they are joined by Nevada and eastern California. I downloaded this map directly from the CDC, but this time, the map is in terms of Age Adjusted Mortality Rates, that is lives lost per 100,000 persons, relative to some ideal, people living in Minnesota, Colorado, and Massachusetts, I suppose. As before, the red areas are those with a higher cardiac death rates. Why are West Californians healthier and folks in Minnesota and Colorado, perhaps because they exercise more, and exercise is a good thing, but these could also be areas with better healthcare, or fewer opioids. Some cities are healthier, some are worse. Why?.
Things have been getting worse in recent years. From 2019 to 2022, the national Cardio-vascular disease caused AAMR increased by 9.3%. Some of this may be COVID or the COVID vaccine, I suppose, or depression. Men seem to be hit harder than women, with the same regional differences. As shown in the map at right, southeast rural men have a lifespan more than 4 years shorter than the national average, or about 7 years shorter than that for women. And this is on top of their already significantly shorter lifespan compared to other developed countries. There’s no obvious reason.
As a marketing thought, assuming that the cause of cardiac death is that people eat high-carb, high fat meals, then the owners of Waffle House might have noticed, and chosen to build there. If so this would be a case where apparent causation is reversed: the relationship between Waffle houses and death is that Waffle houses were built where people were dying of heart disease. It’s a scary thought, but not unlikely. I’d expect new Waffle houses would appear in mid-Michigan, mid Georgia, northern New Jersey, and NW Indiana. These are places where people will likely like the food and ambiance. I’ve taken a light hearted view here because the alternative is too depressing. These rates are dramatic and horrible. I hope RFK Jr. will help increase US lifespans, but have no great faith in him. Trump gave him two years to show significant improvements.
Robert Buxbaum, February 24, 2025.
