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Parcha V, Kalra R, Best AF, Patel N, Suri SS, Wang TJ, Arora G, Arora P. Geographic Inequalities in Cardiovascular Mortality in the United States: 1999 to 2018. Mayo Clin Proc 2021; 96:1218-1228. [PMID: 33840523 DOI: 10.1016/j.mayocp.2020.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/24/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the trends in cardiovascular, ischemic heart disease (IHD), stroke, and heart failure mortality in the stroke belt in comparison with the rest of the United States. PATIENTS AND METHODS We evaluated the nationwide mortality data of all Americans from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2018. Cause-specific deaths were identified in the stroke belt and nonstroke belt populations using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. The relative percentage gap was estimated as the absolute difference computed relative to nonstroke belt mortality. Piecewise linear regression and age-period-cohort modeling were used to assess, respectively, the trends and to forecast mortality across the 2 regions. RESULTS The cardiovascular mortality rate (per 100,000 persons) was 288.3 (95% CI, 288.0 to 288.6; 3,684,273 deaths) in the stroke belt region and 251.2 (95% CI, 251.0 to 251.3; 13,296,164 deaths) in the nonstroke belt region. In the stroke belt region, age-adjusted mortality rates due to all cardiovascular causes (average annual percentage change [AAPC] in mortality rates, -2.4; 95% CI, -2.8 to -2.0), IHD (AAPC, -3.8; 95% CI, -4.2 to -3.5), and stroke (AAPC, -2.8; 95% CI, -3.4 to -2.1) declined from 1999 to 2018. A similar decline in cardiovascular (AAPC, -2.5; 95% CI, -3.0 to -2.0), IHD (AAPC, -4.0; 95% CI, -4.3 to -3.7), and stroke (AAPC, -2.9; 95% CI, -3.2 to -2.2) mortality was seen in the nonstroke belt region. There was no overall change in heart failure mortality in both regions (PAAPC>.05). The cardiovascular mortality gap was 11.8% in 1999 and 15.9% in 2018, with a modest reduction in absolute mortality rate difference (~7 deaths per 100,000 persons). These patterns were consistent across subgroups of age, sex, race, and urbanization status. An estimated 101,953 additional cardiovascular deaths need to be prevented from 2020 to 2025 in the stroke belt to ameliorate the gap between the 2 regions. CONCLUSION Despite the overall decline, substantial geographic disparities in cardiovascular mortality persist. Novel approaches are needed to attenuate the long-standing geographic inequalities in cardiovascular mortality in the United States, which are projected to increase.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis
| | - Ana F Best
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Nirav Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Sarabjeet S Suri
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Thomas J Wang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL.
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Parcha V, Malla G, Suri SS, Kalra R, Heindl B, Berra L, Fouad MN, Arora G, Arora P. Geographic Variation in Racial Disparities in Health and Coronavirus Disease-2019 (COVID-19) Mortality. Mayo Clin Proc Innov Qual Outcomes 2020; 4:703-716. [PMID: 33043273 PMCID: PMC7538135 DOI: 10.1016/j.mayocpiqo.2020.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the race-stratified state-level prevalence of health determinants and the racial disparities in coronavirus disease 2019 (COVID-19) cumulative incidence and mortality in the United States. Patients and Methods The age-adjusted race-stratified prevalence of comorbidities (hypertension, diabetes, dyslipidemia, and obesity), preexisting medical conditions (pulmonary disease, heart disease, stroke, kidney disease, and malignant neoplasm), poor health behaviors (smoking, alcohol abuse, and physical inactivity), and adverse socioeconomic factors (education, household income, and health insurance) was computed in 435,139 American adult participants from the 2017 Behavioral Risk Factor Surveillance System survey. Correlation was assessed between health determinants and the race-stratified COVID-19 crude mortality rate and infection-fatality ratio computed from respective state public health departments in 47 states. Results Blacks had a higher prevalence of comorbidities (63.3%; 95% CI, 62.4% to 64.2% vs 55.1%; 95% CI, 54.7% to 55.5%) and adverse socioeconomic factors (47.0%; 95% CI, 46.0% to 47.9% vs 30.9%; 95% CI, 30.6% to 31.3%) than did whites. The prevalence of preexisting medical conditions was similar in blacks (30.4%; 95% CI, 28.8% to 32.1%) and whites (30.8%; 95% CI, 30.2% to 31.4%). The prevalence of poor health behaviors was higher in whites (57.2%; 95% CI, 56.3% to 58.0%) than in blacks (50.2%; 95% CI,46.2% to 54.2%). Comorbidities and adverse socioeconomic factors were highest in the southern region, and poor health behaviors were highest in the western region. The cumulative incidence rate (per 100,000 persons) was 3-fold higher in blacks (1546.4) than in whites (540.4). The crude mortality rate (per 100,000 persons) was 2-fold higher in blacks (83.2) than in whites (33.2). However, the infection-fatality ratio (per 100 cases) was similar in whites (6.2) and blacks (5.4). Within racial groups, the geographic distribution of health determinants did not correlate with the state-level COVID-19 mortality and infection-fatality ratio (P>.05 for all). Conclusion Racial disparities in COVID-19 are largely driven by the higher cumulative incidence of infection in blacks. There is a discordance between the geographic dispersion of COVID-19 mortality and the regional distribution of health determinants.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Gargya Malla
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Sarabjeet S Suri
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN
| | - Brittain Heindl
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Pulmonary Medicine, Massachusetts General Hospital, Boston, MA
| | - Mona N Fouad
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL.,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL
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Smith LM, Stroup WW, Marx DB. POISSON COKRIGING AS A GENERALIZED LINEAR MIXED MODEL. SPATIAL STATISTICS 2020; 35:100399. [PMID: 32864321 PMCID: PMC7451665 DOI: 10.1016/j.spasta.2019.100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
It is often of interest to predict spatially correlated count outcomes that follow a Poisson distribution. For example, in the environmental sciences we may want to predict pollen counts using temperature or precipitation data as auxiliary variables. To predict a Poisson outcome variable in the presence of an auxiliary variable, Poisson cokriging as a Generalized Linear Mixed Model (GLMM) is proposed. This model has a bivariate structure with a Poisson outcome variable and an auxiliary variable. A covariance matrix similar to that used in cokriging is assumed. A simulation study and a real data example using the number of microplastics in the digestive tracts of fish are presented. The results showed that Poisson cokriging methodology can be applied successfully in practice with small average errors and coverage close to 95%. The Poisson cokriging model can be a useful tool for spatial prediction.
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Affiliation(s)
- Lynette M. Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, USA
| | - Walter W. Stroup
- Department of Statistics, University of Nebraska-Lincoln, 340 Hardin Hall North Wing, Lincoln, NE 68583-0963, USA
| | - David B. Marx
- Department of Statistics, University of Nebraska-Lincoln, 340 Hardin Hall North Wing, Lincoln, NE 68583-0963, USA
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Kim JH, Lewis TT, Topel ML, Mubasher M, Li C, Vaccarino V, Mujahid MS, Sims M, Quyyumi AA, Taylor HA, Baltrus PT. Identification of Resilient and At-Risk Neighborhoods for Cardiovascular Disease Among Black Residents: the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study. Prev Chronic Dis 2019; 16:E57. [PMID: 31074715 PMCID: PMC6513475 DOI: 10.5888/pcd16.180505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Despite the growing interest in place as a determinant of health, areas that promote rather than reduce cardiovascular disease (CVD) in blacks are understudied. We performed an ecologic analysis to identify areas with high levels of CVD resilience and risk among blacks from a large southern, US metropolitan area. METHODS We obtained census tract-level rates of cardiovascular deaths, emergency department (ED) visits, and hospitalizations for black adults aged 35 to 64 from 2010 through 2014 for the Atlanta, Georgia, metropolitan area. Census tracts with substantially lower rates of cardiovascular events on the basis of neighborhood socioeconomic status were identified as resilient and those with higher rates were identified as at risk. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CIs) of being classified as an at-risk versus resilient tract for differences in census-derived measures. RESULTS We identified 106 resilient and 121 at-risk census tracts, which differed in the rates per 5,000 person years of cardiovascular outcomes (mortality, 8.13 vs 13.81; ED visits, 32.25 vs 146.3; hospitalizations, 26.69 vs 130.0), despite similarities in their median black income ($46,123 vs $45,306). Tracts with a higher percentage of residents aged 65 or older (odds ratio [OR], 2.29; 95% CI, 1.41-3.85 per 5% increment) and those with incomes less than 200% of the federal poverty level (OR, 1.19; 95% CI, 1.02-1.39 per 5% increment) and greater Gini index (OR, 1.56; 95% CI, 1.19- 2.07 per 0.05 increment) were more likely to be classified as at risk than resilient neighborhoods. DISCUSSION Despite matching on median income level, at-risk neighborhoods for CVD among black populations were associated with a higher prevalence of socioeconomic indicators of inequality than resilient neighborhoods.
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Affiliation(s)
- Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Matthew L Topel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mohamed Mubasher
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Chaohua Li
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Herman A Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Peter T Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia.,National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia.,Morehouse School of Medicine, National Center for Primary Care, Room 310, 720 Westview Dr, Atlanta, GA 30310.
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Vaughan AS, Quick H, Schieb L, Kramer MR, Taylor HA, Casper M. Changing rate orders of race-gender heart disease death rates: An exploration of county-level race-gender disparities. SSM Popul Health 2019; 7:100334. [PMID: 30581967 PMCID: PMC6299149 DOI: 10.1016/j.ssmph.2018.100334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/02/2018] [Accepted: 11/28/2018] [Indexed: 12/17/2022] Open
Abstract
A holistic view of racial and gender disparities that simultaneously compares multiple groups can suggest associated underlying contextual factors. Therefore, to more comprehensively understand temporal changes in combined racial and gender disparities, we examine variations in the orders of county-level race-gender specific heart disease death rates by age group from 1973-2015. We estimated county-level heart disease death rates by race, gender, and age group (35-44, 45-54, 55-64, 65-74, 75-84, ≥ 85, and ≥ 35) from the National Vital Statistics System of the National Center for Health Statistics from 1973-2015. We then ordered these rates from lowest to highest for each county and year. The predominant national rate order (i.e., white women (WW) < black women (BW) < white men (WM) < black men (BM)) was most common in younger age groups. Inverted rates for black women and white men (WW
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Affiliation(s)
- Adam S. Vaughan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States
| | - Harrison Quick
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA 19104, United States
| | - Linda Schieb
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States
| | - Herman A. Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, United States
| | - Michele Casper
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, United States
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Van Dyke ME, Komro KA, Shah MP, Livingston MD, Kramer MR. State-level minimum wage and heart disease death rates in the United States, 1980-2015: A novel application of marginal structural modeling. Prev Med 2018; 112:97-103. [PMID: 29625130 PMCID: PMC5970990 DOI: 10.1016/j.ypmed.2018.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 12/18/2022]
Abstract
Despite substantial declines since the 1960's, heart disease remains the leading cause of death in the United States (US) and geographic disparities in heart disease mortality have grown. State-level socioeconomic factors might be important contributors to geographic differences in heart disease mortality. This study examined the association between state-level minimum wage increases above the federal minimum wage and heart disease death rates from 1980 to 2015 among 'working age' individuals aged 35-64 years in the US. Annual, inflation-adjusted state and federal minimum wage data were extracted from legal databases and annual state-level heart disease death rates were obtained from CDC Wonder. Although most minimum wage and health studies to date use conventional regression models, we employed marginal structural models to account for possible time-varying confounding. Quasi-experimental, marginal structural models accounting for state, year, and state × year fixed effects estimated the association between increases in the state-level minimum wage above the federal minimum wage and heart disease death rates. In models of 'working age' adults (35-64 years old), a $1 increase in the state-level minimum wage above the federal minimum wage was on average associated with ~6 fewer heart disease deaths per 100,000 (95% CI: -10.4, -1.99), or a state-level heart disease death rate that was 3.5% lower per year. In contrast, for older adults (65+ years old) a $1 increase was on average associated with a 1.1% lower state-level heart disease death rate per year (b = -28.9 per 100,000, 95% CI: -71.1, 13.3). State-level economic policies are important targets for population health research.
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Affiliation(s)
- Miriam E Van Dyke
- 1518 Clifton Rd. NE, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Kelli A Komro
- 1518 Clifton Rd. NE, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Monica P Shah
- 1518 Clifton Rd. NE, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Melvin D Livingston
- 3500 Camp Bowie Blvd., Department of Biostatistics and Epidemiology, University of North Texas Health Sciences Center, Fort Worth, TX 76107, USA.
| | - Michael R Kramer
- 1518 Clifton Rd. NE, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Jackson BE, Oates GR, Singh KP, Shikany JM, Fouad MN, Partridge EE, Bae S. Disparities in chronic medical conditions in the Mid-South. ETHNICITY & HEALTH 2017; 22:196-208. [PMID: 27680406 PMCID: PMC5396537 DOI: 10.1080/13557858.2016.1232805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study examined differences in socio-demographic characteristics and health behaviors relevant to chronic medical conditions (CMCs) in the Mid-South region (Alabama, Mississippi, Louisiana, Kentucky, Tennessee, and Arkansas), and identified subpopulations with increased burden of chronic disease. METHODS Data were obtained from the 2013 Behavioral Risk Factor Surveillance System. The top five most prevalent CMCs in the Mid-South were analyzed: asthma, high blood pressure (HBP), obesity, arthritis, and depression. Adjusted odds ratios (AOR) and confidence intervals (CI) of race-gender combinations were estimated using logistic regression. Differences in associations between socio-demographic characteristics and CMCs according to income were also examined. RESULTS The weighted prevalence estimates of the top five CMCs ranged from 66% (asthma) to 20% (depression). Higher income and employment were associated with better outcomes in all five CMCs. Higher educational attainment and physical activity were associated with better HBP, obesity, and arthritis status. Black and white females had higher odds of asthma compared to white males (black AOR = 1.7, CI: 1.1-2.6, white AOR = 1.7, CI: 1.3-2.2). Black males had lower odds of arthritis (AOR = 0.8, CI: 0.6-0.9), while white females had higher odds (AOR = 1.3, CI: 1.2-1.4). Similarly, the odds of depression were lower among black males (AOR = 0.5, CI: 0.4-0.6) and higher among white females (AOR = 2.2, CI: 2.0-2.5). Income-related differences by race were observed for HBP and obesity. CONCLUSION Disparities in CMCs are associated with income and disproportionately affect the black population. In the Mid-South, race and gender disparities in the top five chronic conditions are more prominent among higher-income rather than lower-income individuals.
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Affiliation(s)
- Bradford E. Jackson
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabriela R. Oates
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karan P. Singh
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M. Shikany
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mona N. Fouad
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward E. Partridge
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sejong Bae
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Oates GR, Jackson BE, Partridge EE, Singh KP, Fouad MN, Bae S. Sociodemographic Patterns of Chronic Disease: How the Mid-South Region Compares to the Rest of the Country. Am J Prev Med 2017; 52:S31-S39. [PMID: 27989290 PMCID: PMC5171223 DOI: 10.1016/j.amepre.2016.09.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/26/2016] [Accepted: 09/06/2016] [Indexed: 12/29/2022]
Abstract
INTRODUCTION States in the Mid-South region are among the least healthy in the nation. This descriptive study examines sociodemographic differences in the distribution of chronic diseases and health-related behaviors in the Mid-South versus the rest of the U.S., identifying subgroups at increased risk of chronic disease. METHODS Data were obtained from the 2013 Behavioral Risk Factor Surveillance System; analyses were completed in January 2016. Twelve chronic health conditions were assessed: obesity, diabetes, high blood pressure, coronary heart disease, myocardial infarction, stroke, chronic kidney disease, cancer, arthritis, asthma, chronic obstructive pulmonary disease, and depression. Evaluated health-related behaviors included smoking, physical activity, and fruit and vegetable consumption. Age-standardized percentages were reported using complex survey design parameters to enhance generalizability. RESULTS The Mid-South population had increased rates of chronic disease and worse health-related behaviors than the rest of the U.S. POPULATION Mid-South blacks had the highest percentages of obesity, diabetes, high blood pressure, and stroke of all subgroups, along with lower physical activity and fruit and vegetable consumption. In both races and regions, individuals with lower income and education had higher rates of chronic disease and unhealthy behaviors than those with higher income and education. However, black men in both regions had higher obesity and cancer rates in the higher education category. In general, education-level disparities were more pronounced in health-related behaviors, whereas income-level disparities were more pronounced in chronic health conditions. CONCLUSIONS Future studies should test tailored interventions to address the specific needs of population subgroups in order to improve their health.
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Affiliation(s)
- Gabriela R Oates
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Bradford E Jackson
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Edward E Partridge
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karan P Singh
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mona N Fouad
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sejong Bae
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
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Casper M, Kramer MR, Quick H, Schieb LJ, Vaughan AS, Greer S. Changes in the Geographic Patterns of Heart Disease Mortality in the United States: 1973 to 2010. Circulation 2016; 133:1171-80. [PMID: 27002081 PMCID: PMC4836838 DOI: 10.1161/circulationaha.115.018663] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality. METHODS AND RESULTS Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged ≥35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases. A fully Bayesian spatiotemporal model was used to produce precise rate estimates, even in counties with small populations. A substantial shift in the concentration of high-rate counties from the Northeast to the Deep South was observed, along with a concentration of slow-decline counties in the South and a nearly 2-fold increase in the geographic inequality among counties. CONCLUSIONS The dramatic change in the geographic patterns of heart disease mortality during 40 years highlights the importance of small-area surveillance to reveal patterns that are hidden at the national level, gives communities the historical context for understanding their current burden of heart disease, and provides important clues for understanding the determinants of the geographic disparities in heart disease mortality.
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Affiliation(s)
- Michele Casper
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.).
| | - Michael R Kramer
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.)
| | - Harrison Quick
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.)
| | - Linda J Schieb
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.)
| | - Adam S Vaughan
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.)
| | - Sophia Greer
- From Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.C., M.R.K., H.Q., L.J.S., A.S.V., S.G.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (M.R.K., A.S.V.)
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Singh GK, Azuine RE, Siahpush M, Williams SD. Widening Geographical Disparities in Cardiovascular Disease Mortality in the United States, 1969-2011. Int J MCH AIDS 2015; 3:134-49. [PMID: 27621993 PMCID: PMC5005988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study examined trends in geographical disparities in cardiovascular-disease (CVD) mortality in the United States between 1969 and 2011. METHODS National vital statistics data and the National Longitudinal Mortality Study were used to estimate regional, state, and county-level disparities in CVD mortality over time. Log-linear, weighted least squares, and Cox regression were used to analyze mortality trends and differentials. RESULTS During 1969-2011, CVD mortality rates declined fastest in New England and Mid-Atlantic regions and slowest in the Southeast and Southwestern regions. In 1969, the mortality rate was 9% higher in the Southeast than in New England, but the differential increased to 48% in 2011. In 2011, Southeastern states, Mississippi and Alabama, had the highest CVD mortality rates, nearly twice the rates for Minnesota and Hawaii. Controlling for individual-level covariates reduced state differentials. State- and county-level differentials in CVD mortality rates widened over time as geographical disparity in CVD mortality increased by 50% between 1969 and 2011. Area deprivation, smoking, obesity, physical inactivity, diabetes prevalence, urbanization, lack of health insurance, and lower access to primary medical care were all significant predictors of county-level CVD mortality rates and accounted for 52.7% of the county variance. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS Although CVD mortality has declined for all geographical areas in the United States, geographical disparity has widened over time as certain regions and states, particularly those in the South, have lagged behind in mortality reduction. Geographical disparities in CVD mortality reflect inequalities in socioeconomic conditions and behavioral risk factors. With the global CVD burden on the rise, monitoring geographical disparities, particularly in low- and middle-income countries, could indicate the extent to which reductions in CVD mortality are achievable and may help identify effective policy strategies for CVD prevention and control.
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Affiliation(s)
- Gopal K Singh
- The Center for Global Health and Health Policy, Global Health and Education Projects, Riverdale, Maryland 20738, USA
| | - Romuladus E Azuine
- The Center for Global Health and Health Policy, Global Health and Education Projects, Riverdale, Maryland 20738, USA
| | - Mohammad Siahpush
- University of Nebraska Medical Center, Department of Health Promotion, Social and Behavioral Health, Omaha, NE 68198-4365, USA
| | - Shanita D Williams
- US Department of Health and Human Services, Rockville, Maryland 20857, USA
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