Abstract MP49: Application Of A Novel Assessment Of County-level Cardiovascular Health Profile And Its Association With County-level Disease Rates

Abstract

Background: The AHA’s definition of cardiovascular health (CVH) is based on seven metrics known as Life’s Simple 7 (LS7): smoking, diet, obesity, physical inactivity, high blood cholesterol, high blood pressure, and diabetes. Although used to evaluate CVH at the national and individual level, its use as a local county-level measure of CVH has not yet been studied. Our objective was to create a modification of LS7 using publicly available data to estimate county-level CVH and to determine its association with CVH outcomes in all 100 counties of North Carolina (NC). Methods and Results: Using data on all the LS7 metrics collected by the CDC, USDA, BRFSS, and Community Health Assessments, we created a Modified LS7 scoring system, calculated scores for all 100 counties in NC, and created a regression model that predicts county-level hospital discharge rates for diseases and disorders of the circulatory system (Figure 1). Modified LS7 scores ranged from 60.8 to 80.6 (median = 73.1, SD = 3.9). Hospital discharge rates per 100,000 population ranged from 753.4 to 2223.4 (median = 1345.6, SD = 328.7). We found a negative correlation (R-squared = 0.610) between Modified LS7 scores and county-level hospital discharge rates. Counties in the mountain and piedmont regions had significantly higher mean Modified LS7 scores (74.3, 95% CI: 73.5-75.2; 73.9, 95% CI: 72.8-75.0) and lower mean discharge rates (1167.1, 95% CI: 1074.7-1259.5; 1273.9, 95% CI: 1181.4-1366.2) than counties in the coastal plains region (70.7, 95% CI: 69.4-72.0; 1612.3, 95% CI: 1518.5-1706.1). Studentized residuals and leverage points were used to identify five low performing counties and two high performing counties of interest for further analyses. Conclusions: The coastal region of NC was found to have significantly higher CVH risk and poorer CVH outcomes compared to the piedmont and mountain regions. The Modified LS7 model provides a novel approach to examine county-level variation in CVH that had previously only been reported at the national, state or individual level.