4. Disease Statistics
- Deaths From All Causes and Deaths
From Cardiovascular, Lung, and Blood Diseases, U.S., 1988 and 2008
- Deaths From Specific Cardiovascular,
Lung, and Blood Diseases, U.S., 2008
- Age-Adjusted Death Rates for
Cardiovascular and Noncardiovascular Diseases, U.S., 1963, 1988, and
2008
- Deaths Under Age 1 Year Due to
Cardiovascular and Lung Diseases, U.S., 2008
- Prevalence of Common Cardiovascular
and Lung Diseases, U.S., 2005-2010
- Direct and Indirect Economic Costs
of Illness by Major Diagnosis, U.S., 2008
Cardiovascular, lung, and blood diseases constitute a
large morbidity, mortality, and economic burden on individuals, families, and
the Nation. Common forms are atherosclerosis, hypertension, COPD, and
blood-clotting disorders—embolisms and thromboses. The most serious
atherosclerotic diseases are CHD, as manifested by heart attack and angina
pectoris, and cerebrovascular disease, as manifested by stroke.
In 2008, cardiovascular, lung, and blood diseases
accounted for 1,052,000 deaths and 43 percent of all deaths in the United
States (p. 35). The estimated economic cost in 2008 for these diseases
was $392 billion, 22 percent of the total economic costs of illness, injuries,
and death (p. 51). Of all diseases, heart disease is the leading cause of
death; chronic lower respiratory diseases (CLRD), which includes COPD and
asthma, ranks third (behind cancer); and cerebrovascular disease is fourth (p.
38). Cardiovascular and lung diseases account for 3 of the 4 leading
causes of death (p. 38) and 4 of the 10 leading causes of infant death (p.
44). Hypertension, asthma, CHD, and COPD are especially prevalent and
account for substantial morbidity in Americans (p. 47).
The purpose of the biomedical research conducted by
the NHLBI is to contribute to the prevention and treatment of cardiovascular,
lung, and blood diseases and sleep disorders. National disease statistics
show that by mid-century, morbidity and mortality from these diseases had
reached record high levels. Since then, however, substantial improvements
have been achieved, especially over the past 40 years, as shown by the
significant decline in mortality rates. Because many of these diseases
begin early in life, their early detection and control can reduce the risk of
disability and can delay death. Although important advances have been
made in the treatment and control of cardiovascular, lung, and blood diseases,
these diseases continue to be a major burden on the Nation.
Mortality statistics in this chapter are for diseases
or conditions classified as the underlying cause of death. Heart failure,
however, is never truly an underlying cause even though 56,830 deaths in 2008
were nominally coded to it as the underlying cause. Therefore, in this
chapter, mortality statistics attributed to any mention of heart failure
represent it as either the underlying cause or a contributing cause of
death.
Cardiovascular Diseases
- In 2008, CVD caused 812,000 deaths—33 percent
of all deaths (p. 35).
- Heart disease is the leading cause of death; the
main form, CHD, caused 405,000 deaths in 2008 (pp. 36, 38).
- The annual number of deaths from CVD increased
substantially from 1900 to 1970 and remains high (p. 37).
- The death rate (not age-adjusted) for CVD increased
from 1920 until it peaked in 1968. Since then, the trend has been
downward. In 2008, the rate was below the all-time low in 1900 (p.
37).
- Cerebrovascular disease, the fourth leading cause
of death, accounted for 134,000 deaths in 2008 (pp. 36, 38).
- Heart disease is second only to all cancers
combined in years of potential life lost (p. 38).
- Heart disease is the leading cause of death in
blacks and Hispanics, but second to cancer in Asians and American
Indians. Stroke ranks as the third or fourth leading cause of death in
the minority groups, except in American Indians, where it ranks seventh (p.
38).
- Deaths with heart failure as the underlying or
contributing cause increased from 1970 to 1993 and then remained constant to
2008 (p. 39).
- From 1999 to 2008, death rates for CHD and stroke
declined in males and females of all racial/ethnic groups. CHD mortality
remained highest in the black population and lowest in the Asian
population. Stroke mortality continues to be highest in the black
population (p. 40).
- Because of the rapid decline in mortality from CHD
since the peak in 1968, there were 1,174,000 fewer deaths from CHD in 2008 than
would have occurred if there had been no decline (p. 41).
- Substantial improvements have been made in the
treatment of CVD. Since 1975 or 1985, the percent of hospitalizations for
AMI, stroke, heart failure, and cardiac dysrhythmias that were discharged dead
declined appreciably (p. 41).
- The decline in CHD mortality began earlier in the
United States than in most countries and outpaced that in most countries until
the 1990s (only selected countries are shown) (p. 42).
- From 1999 to 2008, the percentage decline in death
rates for CHD and stroke was fairly similar for whites and blacks (p. 43).
- In 2008, an estimated 82.6 million persons in the
United States had CVD, including 76.4 million with hypertension and 16.3
million with CHD (p. 47).
- Since the 1960s, there has been a substantial
reduction in the prevalence of CVD risk factors: hypertension,
smoking, and high cholesterol, but not overweight. The large decline in
prevalence of hypertension from 1976–1980 to 1988–1994 was
followed by a slightly higher prevalence in 1999–2004 and
2005–2008 (p. 48).
- From 1976–1980 to 2005–2008, the
percentage of persons with hypertension who were aware of their condition, on
treatment for it, and having their blood pressure under control increased
substantially (p. 49).
- A 2005–2008 national survey showed only about
48 percent of hypertensive patients (systolic BP ≥ 140 mmHg or
diastolic BP ≥ 90 mmHg or on antihypertensive medication) had their
condition under control (p. 49).
- Hospitalization rates for heart failure in those
aged 45 to 64 years increased from 1971 to 1993 and remained stable to
2009. Rates for those aged 65 years and older increased from 1971
to 1998 and remained relatively stable until 2005; rates then declined through
2009 (p. 50).
- The estimated economic cost of CVD for 2008 was
$298 billion:
- $179 billion in direct health
expenditures
- $118 billion in indirect cost of mortality (p.
51).
Lung Diseases
- Lung diseases, excluding lung cancer, caused an
estimated 242,000 deaths in 2008 (p. 35).
- CLRD caused 141,000 deaths in 2008 and is the third
leading cause of death (pp. 36, 38).
- From 1999 to 2008, death rates for asthma declined
in both black and white males and females; death rates for COPD declined in
both black and white males but rose in both black and white females (p.
43).
- From 1980 to 2008, infant death rates for various
lung diseases declined markedly (p. 43).
- In 2008, of the 10 leading causes of infant
mortality, 4 were lung diseases or had a lung disease component (p. 44).
From 1998 to 2008, changes in mortality for the causes were:
- Congenital malformations (-9 percent)
- Disorders of short gestation (-3 percent)
- Sudden infant death syndrome (-27
percent)
- Respiratory distress syndrome (-51
percent).
- In 2008, approximately one in six deaths in
children under 1 year of age was due to a lung disease (p. 44).
- From 1980 to 2008, the CLRD death rate for females
in the United States increased appreciably compared with the rates in several
other countries (p. 45).
- From 2000 to 2008, death rates for CLRD decreased
slightly for Asian and Hispanic females but were stable for American Indian and
non-Hispanic white and non-Hispanic black females. For males, the rates
decreased in all racial/ethnic groups (p. 46).
- Among the sleep disorders, sleep apnea is
increasingly being recognized as an important health problem, which can lead to
serious consequences. From 2000 to 2009, physician office visits for
sleep apnea increased from 2 to 3.7 million (p. 46).
- Asthma is a common chronic condition, particularly
in children (pp. 47, 48, 50).
- The economic cost of asthma, COPD, and pneumonia
was $89 billion in 2008:
- $68 billion in direct health expenditures
- $21 billion in indirect cost of mortality (p.
51).
Blood Diseases
- Approximately 10,000 deaths were attributed to
blood diseases in 2008 (p. 35). These include the following:
- 5,000 due to anemias
- 1,800 due to coagulation
defects
- 800 due to purpura
- 2,400 due to other blood
diseases.
- A large proportion of deaths from AMI,
cerebrovascular disease, and peripheral artery disease involve blood-clotting
problems (no estimate available).
- In 2008, anemias cost the Nation’s economy $6
billion:
- $5 billion in direct health expenditures
- $1 billion in indirect cost of mortality (p.
51).
Deaths From All Causes and Deaths
From Cardiovascular, Lung, and Blood Diseases, U.S., 1988 and 2008
| Cause of Death |
1988 Number of Deaths |
1988 Percent of Total |
2008 Number of Deaths |
2008 Percent of Total |
| All Causes |
2,167,999 |
100 |
2,471,984 |
100 |
|
All Cardiovascular, Lung, and
Blood Diseases |
1,181,646 |
55 |
1,051,502 |
43 |
|
Cardiovascular
Diseases |
979,788 |
45 |
811,940 |
33 |
|
Blood |
8,649 |
<1 |
10,066 |
<1 |
|
Lung |
205,798* |
9 |
242,350** |
10 |
| All Other Causes |
986,353 |
45 |
1,420,482 |
57 |
* Includes 12,931 CVD deaths due to pulmonary heart
disease. ** Includes 12,854 CVD deaths involving pulmonary heart
disease. Source: Vital Statistics of the United States, National
Center for Health Statistics (NCHS).
|
Deaths
by Major Causes, U.S., 2008 |
Deaths
From Cardiovascular, Lung, and Blood Diseases, U.S., 2008 |
 Text-only with data
points |
 Text-only with data
points |
*Excludes 12,854 deaths from
pulmonary heart disease (0.5%).
Source: Vital Statistics of the United States, NCHS. |
|
Deaths From Specific
Cardiovascular, Lung, and Blood Diseases, U.S., 2008
| Cause of Death |
Cardiovascular Deaths (Thousands) |
Lung Deaths (Thousands) |
Blood Deaths (Thousands) |
| Acute
Myocardial Infarction |
134 |
|
* |
| Other
Coronary Heart Disease |
270 |
|
|
|
Cerebrovascular Diseases (Stroke) |
134 |
|
* |
| Other
Atherosclerosis |
28 |
|
|
| Pulmonary
Embolism |
7 |
7** |
* |
| Deep Vein
Thrombosis |
2 |
|
* |
| Other
Cardiovascular Diseases |
236 |
6** |
|
| Bleeding
and Red Blood Cell Diseases |
|
|
10 |
| Chronic
Obstructive Pulmonary Disease |
|
138 |
|
| Asthma |
|
3 |
|
| Influenza
and Pneumonia |
|
56 |
|
| Neonatal
Pulmonary Disorders |
|
4 |
|
|
Interstitial Lung Diseases |
|
7 |
|
| Lung
Diseases Due to External Agents |
|
18 |
|
| Other Lung
Diseases |
|
3 |
|
|
Total |
812 |
242 |
10 |
* Deaths from pulmonary disorders also included as
CVD. ** Deaths from anemias, coagulation defects, purpura, and other blood
diseases. Deaths attributed to blood-clotting diseases classified to AMI,
stroke, and peripheral artery disease are not included. Most deaths
from this cardiovascular disease can be classified as a blood-clotting
disease. No good estimate is available. Numbers do not sum to
the total due to rounding. Note: Total, excluding overlap, is 1,051,502.
Source: Vital Statistics of the United States, NCHS.
* Includes heart failure, cardiac dysrhythmias,
hypertensive disease, deep vein thrombosis, and other heart and blood vessel
diseases. Note: Numbers do not sum to 100 percent due to rounding.
Source: Vital Statistics of the United States, NCHS.
Deaths From Cardiovascular Diseases, U.S.,
1900–2008
Source: Vital Statistics of the United States,
NCHS.
Death Rates* for Cardiovascular Diseases, U.S.,
19002008
*Not age-adjusted. Source: Vital Statistics of the
United States, NCHS.
Ten Leading Causes of Death: Death Rates, U.S.,
2008
* Not age-adjusted. ** Includes 133.3 deaths
per 100,000 population from CHD. CLRD is the term used in the ICD/10
for COPD and asthma. Based on the average remaining years of life up
to age 77 years. Note: Diseases shown in bold are those addressed in
Institute programs. Source: Vital Statistics of the United States,
NCHS.
Ten Leading Causes of Death Among Minority Groups,
U.S., 2008
* Includes deaths among individuals of Asian
extraction and Asian-Pacific Islanders. ** Includes deaths among Aleuts and
Eskimos. Note: Causes of death shown in bold are those addressed in
Institute programs. Source: Vital Statistics of the United States, NCHS.
Age Adjusted Death Rates for
Cardiovascular and Noncardiovascular Diseases, U.S., 1963, 1988,
and 2008
| Cause of Death |
Deaths/100,000 Population* |
Percent Change 1963-2008 |
Percent Change 1988-2008 |
| 1963 |
1988 |
2008 |
| All Causes |
1,346 |
975 |
760 |
-44 |
-22 |
|
Cardiovascular
Diseases |
805 |
450 |
245 |
-70 |
-46 |
|
Coronary Heart
Disease |
478 |
234 |
123 |
-74 |
-48 |
|
Stroke |
174 |
74** |
41 |
-77 |
-45 |
|
Other |
153 |
142 |
81 |
-47 |
-43 |
|
Noncardiovascular
Diseases |
541 |
525 |
515 |
-5 |
-2 |
|
COPD and Asthma |
16 |
38 |
44 |
167 |
16 |
|
Other |
524 |
487 |
471 |
-10 |
-3 |
* Heart failure as the underlying
cause of death or otherwise mentioned on the death certificate. Note:
Breaks in trend line indicate change in ICD codes. Source: Vital Statistics
of the United States, NCHS.
Age-Adjusted Death Rates for Coronary Heart Disease
by Race/Ethnicity and Sex, U.S., 1999–2008
Age-Adjusted Death Rates for Stroke by Race/Ethnicity
and Sex, U.S., 19992008
Age-Adjusted Death Rates for Coronary Heart Disease,
U.S., 1950–2008 Actual Rate and Expected Rates if Rise Had Continued
or Reached a Plateau
Source: Vital Statistics of the United States,
NCHS.
Common Cardiovascular and Lung Diseases With High
Percentage Discharged Dead From Hospitals, U.S., 1975, 1985, and 2009
Source: National Hospital Discharge Survey (NHDS),
NCHS.
Death Rates* for Coronary Heart Disease in Males,
Ages 3574, in Selected Countries, 19702009
* Age-adjusted to the European Standard
Population. ** United Kingdom for 2008 and 2009; England and Wales for
1970–2007. Source: World Health Organization (WHO) Mortality
Database.
Death Rates* for Coronary Heart Disease in Females,
Ages 3574, in Selected Countries, 19702009
* Age-adjusted to the European Standard
Population. ** United Kingdom for 2008 and 2009; England and Wales for
1970–2007. Source: WHO Mortality Database.
Percent Change in Age-Adjusted Death Rates for
Selected Causes by Race and Sex, U.S., 19992008
Source: Vital Statistics of the United States,
NCHS.
Death Rates for Lung Diseases in Infants, U.S.,
19802008
Source: Vital Statistics of the United States,
NCHS.
Ten Leading Causes of Infant Mortality, U.S.,
2008
* Congenital CVD and congenital respiratory
diseases accounted for 44.6 deaths under age 1 per 100,000 live births (black
bar), which is 34 percent of infant deaths due to all congenital
malformations. ** From 1998 to 2008, congenital CVD
declined 30 percent; congenital malformations of the respiratory system
declined 47 percent; other congenital malformations increased 20 percent.
NA: Not available. Note: Diseases shown in bold are those addressed in
Institute programs. Source: Vital Statistics of the United States,
NCHS.
Deaths Under Age 1 Year Due to
Cardiovascular and Lung Diseases, U.S., 2008
| Cause of Death |
Deaths Under Age 1 |
 Text-only with
data points |
| All Causes |
28,059 |
| Cardiovascular Diseases |
2,121 |
|
Congenital Malformations
|
1,527 |
|
Other |
594 |
|
Lung Diseases |
4,718 |
|
Sudden Infant Death
Syndrome |
2,353 |
|
Respiratory Distress
Syndrome |
640 |
|
Pneumonia |
210 |
|
Bronchopulmonary
Dysplasia (BPD) |
217 |
|
Atelectasis of
Newborn |
335 |
|
Congenital
Malformations |
371 |
|
Other Lung Diseases
|
592 |
| Other Diseases |
21,220 |
Note: Diseases shown in bold are those addressed in
Institute programs. Source: Vital Statistics of the United States,
NCHS.
Death Rates* for Chronic Lower Respiratory Diseases
in Males, Ages 35 Years and Older, in Selected Countries, 1980–2009
* Age-adjusted to the European Standard
Population. ** United Kingdom for 2008 and 2009; England and Wales for
1970–2007 Source: WHO Mortality Database.
Death Rates* for Chronic Lower Respiratory Diseases
in Females, Ages 35 Years and Older, in Selected Countries,
1980–2009
* Age-adjusted to the European Standard
Population. ** United Kingdom for 2008 and 2009; England and Wales for
1970–2007 Source: WHO Mortality Database.
Age-Adjusted Death Rates for Chronic Lower
Respiratory Diseases by Race/Ethnicity and Sex, U.S., 1999–2008
* Non-Hispanic. Source: Vital
Statistics of the United States, NCHS.
Physician Office Visits for Sleep Disorders, U.S.,
2000–2009
Note: Primary and secondary diagnoses. Source:
National Ambulatory Medical Care Survey, NCHS.
Prevalence of Common
Cardiovascular and Lung Diseases, U.S., 2005–2010
| Disease |
Number of Persons |
| Cardiovascular Diseases* |
82,600,000 |
| Hypertension** |
76,400,000 |
| Coronary Heart Disease |
16,300,000 |
| Heart Failure |
5,700,000 |
| Stroke |
7,000,000 |
| Congenital Heart Disease |
1,000,000 |
| Asthma |
39,190,000 |
| COPD§ |
12,481,000 |
* Hypertension, CHD, stroke, or
heart failure. Hypertension is defined as systolic blood pressure ≥ 140
mmHg, or diastolic blood pressure ≥ 90 mmHg, or being on antihypertensive
medication. Source: NHANES, 20052008, NCHS.
Prevalence of Common Cardiovascular and Lung Diseases
by Age, U.S., 20052010
Source: NHIS and NHANES, NCHS.
Age-Adjusted Prevalence of Cardiovascular Disease
Risk Factors in Adults, U.S., 19612010
Notes: Hypertension is defined as systolic blood
pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or being
on antihypertensive medication. High cholesterol is ≥240 mg/dL.
Overweight is BMI ≥25 kg/m2. Data were collected at six time
periods: 19601961 (plotted at 1961), 19711974 (plotted at 1972),
19761980 (plotted at 1978), 19881994 (plotted at 1991),
19992004 (plotted at 2004), and 20052008 (plotted at
2008). Sources: NHIS for smoking, ages ≥18, NCHS; NHANES for the other
risk factors, ages 2074, NCHS.
Hypertensive* Population Aware, Treated, and
Controlled, Ages 18 and Older, U.S., 19761980 to 20052008
* Hypertension is defined as
systolic blood pressure ≥ 140 mm Hg, or diastolic blood pressure
> 90 mm Hg, or being on antihypertensive medication. Source:
NHANES, NCHS.
Adult Population With Hypertension* by Age,
Race/Ethnicity, and Sex, U.S., 20052008
* Hypertension is systolic
blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg, or
being on antihypertensive medication. ** Non-Hispanic.
Sources: NHANES, NCHS.
Hospitalization Rates for Heart Failure, Ages
4564 and 65 and Older, U.S., 19712009
Source: NHDS, NCHS.
Prevalence of Asthma Episodes in Previous 12
Months by Age, U.S., 19972010
Source: NHIS, NCHS.
Direct and Indirect Economic Costs
of Illness by Major Diagnosis, U.S., 2008
| |
Amount
(Dollars in Billions) Direct Cost* |
Amount
(Dollars in Billions) Indirect Cost of Mortality** |
Amount
(Dollars in Billions) Total |
Percent
Distribution Direct Cost |
Percent
Distribution Indirect Cost of Mortality |
Percent
Distribution
Total |
| Cardiovascular Diseases |
$179.3 |
$118.4 |
$297.7 |
15.6% |
19.9% |
17.1% |
| COPD, Asthma, Pneumonia |
67.7 |
21.0 |
88.7 |
5.9 |
3.5 |
5.1 |
| Anemias and Other Deficiencies |
4.7 |
1.2 |
5.9 |
0.4 |
0.2 |
0.3 |
| Subtotal |
251.7 |
140.6 |
392.3 |
21.9 |
23.6 |
22.5 |
| Neoplasms |
77.4 |
124.0 |
201.5 |
6.7 |
20.9 |
11.5 |
| Injury and Poisoning |
77.7 |
101.6 |
179.3 |
6.8 |
17.1 |
10.3 |
| Endocrine, Nutritional, and
Metabolic Diseases |
102.3 |
22.6 |
124.9 |
8.9 |
3.8 |
7.2 |
| Diseases of the Digestive
System |
84.2 |
28.6 |
112.8 |
7.3 |
4.8 |
6.5 |
| Diseases of the Respiratory
System† |
78.5 |
27.4 |
105.9 |
6.8 |
4.6 |
6.1 |
| Diseases of the Musculoskeletal
System |
117.8 |
3.0 |
120.9 |
10.2 |
0.5 |
6.9 |
| Diseases of the Nervous System |
69.7 |
15.4 |
85.2 |
6.1 |
2.6 |
4.9 |
| Mental Disorders |
72.1 |
8.2 |
80.3 |
6.3 |
1.4 |
4.6 |
| Diseases of the Genitourinary
System |
55.5 |
7.7 |
63.2 |
4.8 |
1.3 |
3.6 |
| Infectious and Parasitic
Diseases |
16.2 |
23.9 |
40.1 |
1.4 |
4.0 |
2.3 |
| Normal Live Birth |
34.6 |
— |
34.6 |
3.0 |
— |
2.0 |
| Diseases of the Skin |
24.2 |
0.7 |
24.9 |
2.1 |
0.1 |
1.4 |
| Other and Not Linked to Specific
Condition |
155.8 |
111.8 |
267.7 |
13.6 |
18.8 |
15.3 |
| Total |
$1,150.0
|
$594.8 |
$1,744.8
|
100% |
100% |
100% |
* Direct costs are personal health care
expenditures for hospital and professional services care, prescribed
medications, and home care reported by the Medical Expenditure Panel Survey
(MEPS), Agency for Healthcare Research and Quality (AHRQ), by diagnosis,
excluding nursing home care costs and costs due to comorbidities.
** The mortality cost for each disease group was estimated for 2008
by multiplying the number of deaths by age, sex, and cause of death in 2008 by
the 2007 present value of lifetime earnings (latest available) discounted at 3
percent and projected to 2008 based on a 2008 inflation factor measured from
mean earnings reported by the U.S. Census Bureau.
Includes costs for COPD, asthma, and pneumonia. Note: Estimates are
not available for total lung diseases and blood clotting disorders.
Source: Prepared by NHLBI from direct costs on the MEPS Web site; numbers of
deaths from Vital Statistics of the United States, NCHS; present value of
lifetime earnings from the Institute for Health and Aging, University of
California; and mean earnings from the U.S. Census Bureau.
Total Economic Costs of the Leading Diagnostic
Groups, U.S., 2008
Source: MEPS, AHRQ.
Direct Economic Cost and Percent Distribution for
Selected Conditions by Type of Service, U.S., 2008
| |
Percent Distribution by Type of Service |
| Condition |
Total Direct Cost (in
Billions) |
Hospital Outpatient or Office-Based Provider Visits |
Hospital
Inpatient Stays |
Emergency
Room Visits |
Prescribed Medicines |
Home
Health |
| Heart Disease |
$95.6
|
18.0% |
56.5% |
7.6% |
10.2% |
8.0% |
| COPD, Asthma |
53.7 |
24.6 |
24.4 |
5.7 |
38.0 |
7.4 |
| Hypertension |
47.4 |
27.5 |
13.1 |
3.6 |
45.0 |
10.8 |
| Hyperlipidemia |
38.6 |
23.4 |
3.5 |
0.3 |
70.3 |
2.6 |
| Stroke |
18.8 |
9.5 |
48.3 |
4.9 |
6.2 |
31.0 |
| Other Circulatory Conditions |
17.6 |
26.6 |
59.3 |
5.1 |
4.1 |
4.9 |
| Pneumonia |
14.0 |
5.4 |
85.3 |
4.0 |
1.9 |
3.4 |
| Anemias |
4.7 |
22.8 |
67.9 |
0.7 |
4.2 |
4.4 |
Source: MEPS, Household Component Summary Data
Tables, AHRQ.
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