Geographic Variation in Cardiovascular Health Among American Adults

Vibhu Parcha; Rajat Kalra; Sarabjeet S. Suri; Gargya Malla; Thomas J. Wang; Garima Arora; Pankaj Arora

doi:10.1016/j.mayocp.2020.12.034

Geographic Variation in Cardiovascular Health Among American Adults

Vibhu Parcha, Rajat Kalra, Sarabjeet S. Suri, Gargya Malla, Thomas J. Wang, Garima Arora, Pankaj Arora

Medicine - Cardiology Division

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

OBJECTIVE: To evaluate the contemporary geographic trends in cardiovascular health in the United States and its relationship with geographic distribution of cardiovascular mortality.

METHODS: By use of a retrospective cross-sectional design, the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) was queried to determine the age-adjusted prevalence of cardiovascular health index (CVHI) metrics (sum of ideal blood pressure, blood glucose concentration, lipid levels, body mass index, smoking, physical activity, and diet). Cardiovascular health was estimated as both continuous (0 to 7 points) and categorical (ideal, intermediate, poor) variables from the BRFSS. Age-adjusted cardiovascular mortality for 2017 was obtained from the Centers for Disease Control and Prevention WONDER database.

RESULTS: Among 1,362,529 American adult participants of the BRFSS 2011-2017 and all American residents in 2017, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.005 in 2017 (P trend<.001) nationally, with modest improvement across all regions (P trend<.05 for all). Ideal cardiovascular health prevalence improved in the northeastern (P trend=.03) and southern regions (P trend=.002). In 2017, the prevalence of coronary heart disease (6.8%; 95% CI, 6.5% to 7.1%) and stroke (3.7%; 95% CI, 3.4% to 3.9%) was highest in the southern region. The CVHI score (3.81±0.01) and the prevalence of ideal cardiovascular health (12.2%; 95% CI, 11.7% to 12.7%) were lowest in the southern United States. This corresponded to the higher cardiovascular mortality in the southern region (233.0 [95% CI, 232.2- to 33.8] per 100,000 persons).

CONCLUSION: Despite a modest improvement in CVHI, only 1 in 6 Americans has ideal cardiovascular health with significant geographic differences. These differences correlate with the geographic distribution of cardiovascular mortality. An urgent unmet need exists to mitigate the geographic disparities in cardiovascular morbidity and mortality.

Original language	English (US)
Pages (from-to)	1770-1781
Number of pages	12
Journal	Mayo Clinic Proceedings
Volume	96
Issue number	7
Early online date	Mar 25 2021
DOIs	https://doi.org/10.1016/j.mayocp.2020.12.034
State	Published - Jul 2021

Bibliographical note

Funding Information:
Grant Support: This work is supported by the Minority Health & Health Disparities Research Center , National Institute on Minority Health and Health Disparities ( U54MD000502 ), and the National Institutes of Health Mentored Patient-Oriented Research Award ( 5K23 HL146887-02 ) to Dr Pankaj Arora.

Publisher Copyright:
© 2021 Mayo Foundation for Medical Education and Research

Keywords

Behavioral Risk Factor Surveillance System
Blood Glucose/analysis
Blood Pressure/physiology
Body Mass Index
Cardiovascular Diseases/diagnosis
Cardiovascular System/metabolism
Cross-Sectional Studies
Diet/psychology
Exercise/physiology
Female
Geography
Health Status
Humans
Male
Middle Aged
Mortality
Prevalence
Risk Factors
Smoking/epidemiology
United States/epidemiology

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.mayocp.2020.12.034

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title = "Geographic Variation in Cardiovascular Health Among American Adults",

abstract = "OBJECTIVE: To evaluate the contemporary geographic trends in cardiovascular health in the United States and its relationship with geographic distribution of cardiovascular mortality.METHODS: By use of a retrospective cross-sectional design, the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) was queried to determine the age-adjusted prevalence of cardiovascular health index (CVHI) metrics (sum of ideal blood pressure, blood glucose concentration, lipid levels, body mass index, smoking, physical activity, and diet). Cardiovascular health was estimated as both continuous (0 to 7 points) and categorical (ideal, intermediate, poor) variables from the BRFSS. Age-adjusted cardiovascular mortality for 2017 was obtained from the Centers for Disease Control and Prevention WONDER database.RESULTS: Among 1,362,529 American adult participants of the BRFSS 2011-2017 and all American residents in 2017, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.005 in 2017 (P trend<.001) nationally, with modest improvement across all regions (P trend<.05 for all). Ideal cardiovascular health prevalence improved in the northeastern (P trend=.03) and southern regions (P trend=.002). In 2017, the prevalence of coronary heart disease (6.8%; 95% CI, 6.5% to 7.1%) and stroke (3.7%; 95% CI, 3.4% to 3.9%) was highest in the southern region. The CVHI score (3.81±0.01) and the prevalence of ideal cardiovascular health (12.2%; 95% CI, 11.7% to 12.7%) were lowest in the southern United States. This corresponded to the higher cardiovascular mortality in the southern region (233.0 [95% CI, 232.2- to 33.8] per 100,000 persons). CONCLUSION: Despite a modest improvement in CVHI, only 1 in 6 Americans has ideal cardiovascular health with significant geographic differences. These differences correlate with the geographic distribution of cardiovascular mortality. An urgent unmet need exists to mitigate the geographic disparities in cardiovascular morbidity and mortality.",

keywords = "Behavioral Risk Factor Surveillance System, Blood Glucose/analysis, Blood Pressure/physiology, Body Mass Index, Cardiovascular Diseases/diagnosis, Cardiovascular System/metabolism, Cross-Sectional Studies, Diet/psychology, Exercise/physiology, Female, Geography, Health Status, Humans, Male, Middle Aged, Mortality, Prevalence, Risk Factors, Smoking/epidemiology, United States/epidemiology",

author = "Vibhu Parcha and Rajat Kalra and Suri, {Sarabjeet S.} and Gargya Malla and Wang, {Thomas J.} and Garima Arora and Pankaj Arora",

note = "Funding Information: Grant Support: This work is supported by the Minority Health & Health Disparities Research Center , National Institute on Minority Health and Health Disparities ( U54MD000502 ), and the National Institutes of Health Mentored Patient-Oriented Research Award ( 5K23 HL146887-02 ) to Dr Pankaj Arora. Publisher Copyright: {\textcopyright} 2021 Mayo Foundation for Medical Education and Research",

year = "2021",

month = jul,

doi = "10.1016/j.mayocp.2020.12.034",

language = "English (US)",

volume = "96",

pages = "1770--1781",

journal = "Mayo Clinic Proceedings",

issn = "0025-6196",

publisher = "Elsevier Science",

number = "7",

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TY - JOUR

T1 - Geographic Variation in Cardiovascular Health Among American Adults

AU - Parcha, Vibhu

AU - Kalra, Rajat

AU - Suri, Sarabjeet S.

AU - Malla, Gargya

AU - Wang, Thomas J.

AU - Arora, Garima

AU - Arora, Pankaj

N1 - Funding Information: Grant Support: This work is supported by the Minority Health & Health Disparities Research Center , National Institute on Minority Health and Health Disparities ( U54MD000502 ), and the National Institutes of Health Mentored Patient-Oriented Research Award ( 5K23 HL146887-02 ) to Dr Pankaj Arora. Publisher Copyright: © 2021 Mayo Foundation for Medical Education and Research

PY - 2021/7

Y1 - 2021/7

N2 - OBJECTIVE: To evaluate the contemporary geographic trends in cardiovascular health in the United States and its relationship with geographic distribution of cardiovascular mortality.METHODS: By use of a retrospective cross-sectional design, the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) was queried to determine the age-adjusted prevalence of cardiovascular health index (CVHI) metrics (sum of ideal blood pressure, blood glucose concentration, lipid levels, body mass index, smoking, physical activity, and diet). Cardiovascular health was estimated as both continuous (0 to 7 points) and categorical (ideal, intermediate, poor) variables from the BRFSS. Age-adjusted cardiovascular mortality for 2017 was obtained from the Centers for Disease Control and Prevention WONDER database.RESULTS: Among 1,362,529 American adult participants of the BRFSS 2011-2017 and all American residents in 2017, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.005 in 2017 (P trend<.001) nationally, with modest improvement across all regions (P trend<.05 for all). Ideal cardiovascular health prevalence improved in the northeastern (P trend=.03) and southern regions (P trend=.002). In 2017, the prevalence of coronary heart disease (6.8%; 95% CI, 6.5% to 7.1%) and stroke (3.7%; 95% CI, 3.4% to 3.9%) was highest in the southern region. The CVHI score (3.81±0.01) and the prevalence of ideal cardiovascular health (12.2%; 95% CI, 11.7% to 12.7%) were lowest in the southern United States. This corresponded to the higher cardiovascular mortality in the southern region (233.0 [95% CI, 232.2- to 33.8] per 100,000 persons). CONCLUSION: Despite a modest improvement in CVHI, only 1 in 6 Americans has ideal cardiovascular health with significant geographic differences. These differences correlate with the geographic distribution of cardiovascular mortality. An urgent unmet need exists to mitigate the geographic disparities in cardiovascular morbidity and mortality.

AB - OBJECTIVE: To evaluate the contemporary geographic trends in cardiovascular health in the United States and its relationship with geographic distribution of cardiovascular mortality.METHODS: By use of a retrospective cross-sectional design, the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) was queried to determine the age-adjusted prevalence of cardiovascular health index (CVHI) metrics (sum of ideal blood pressure, blood glucose concentration, lipid levels, body mass index, smoking, physical activity, and diet). Cardiovascular health was estimated as both continuous (0 to 7 points) and categorical (ideal, intermediate, poor) variables from the BRFSS. Age-adjusted cardiovascular mortality for 2017 was obtained from the Centers for Disease Control and Prevention WONDER database.RESULTS: Among 1,362,529 American adult participants of the BRFSS 2011-2017 and all American residents in 2017, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.005 in 2017 (P trend<.001) nationally, with modest improvement across all regions (P trend<.05 for all). Ideal cardiovascular health prevalence improved in the northeastern (P trend=.03) and southern regions (P trend=.002). In 2017, the prevalence of coronary heart disease (6.8%; 95% CI, 6.5% to 7.1%) and stroke (3.7%; 95% CI, 3.4% to 3.9%) was highest in the southern region. The CVHI score (3.81±0.01) and the prevalence of ideal cardiovascular health (12.2%; 95% CI, 11.7% to 12.7%) were lowest in the southern United States. This corresponded to the higher cardiovascular mortality in the southern region (233.0 [95% CI, 232.2- to 33.8] per 100,000 persons). CONCLUSION: Despite a modest improvement in CVHI, only 1 in 6 Americans has ideal cardiovascular health with significant geographic differences. These differences correlate with the geographic distribution of cardiovascular mortality. An urgent unmet need exists to mitigate the geographic disparities in cardiovascular morbidity and mortality.

KW - Behavioral Risk Factor Surveillance System

KW - Blood Glucose/analysis

KW - Blood Pressure/physiology

KW - Body Mass Index

KW - Cardiovascular Diseases/diagnosis

KW - Cardiovascular System/metabolism

KW - Cross-Sectional Studies

KW - Diet/psychology

KW - Exercise/physiology

KW - Female

KW - Geography

KW - Health Status

KW - Humans

KW - Male

KW - Middle Aged

KW - Mortality

KW - Prevalence

KW - Risk Factors

KW - Smoking/epidemiology

KW - United States/epidemiology

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SN - 0025-6196

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ER -

Geographic Variation in Cardiovascular Health Among American Adults

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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