Abstract P116: County Cardiovascular Health is Associated with County-Level Health Care Resources

Abstract

Cardiovascular disease (CVD) remains the leading cause of death in the U.S. Reducing the population burden of CVD will require an increased focus on understanding how to promote and support population-level cardiovascular health (CVH), which will include the ability to measure the presence of CVH, not merely the presence or absence of CVD. Recently, the American Heart Association developed a comprehensive metric designed to measure CVH at the population level. The metric includes smoking, body mass index, physical activity, diet, cholesterol, blood pressure, and blood glucose. The purpose of this study was to assess how population-level CVH is related to the availability of health care providers and services within the county. Data from the Behavioral Risk Factor Surveillance System were used to calculate age-adjusted CVH for each county in 2009. Federal Information Processing Standards codes were used to obtain scores for counties with a sample size of 15 or more. Data on county-level health care services and providers were abstracted from the Area Resource File. The main outcomes were age-standardized mean CVH score. In total, 2236 counties were included in the analysis. Mean CVH score was 3.49 (0.39 SD). After adjustment for county population, county-level CVH score was positively correlated to per capita primary care physicians (rho=0.33, p<0.0001) and nurse practitioners (rho=0.106, p<0.0001). County CVH was also positively and significantly correlated to cardiovascular disease specialists (rho=0.220, p<0.0001). The number of per capita physicians assistants and dieticians / nutritionists were also positively associated with county CVH (rho=0.232, p<0.0001; rho=0.112, p=0.003, respectively). In assessing the effect of the availability of health care facilities, county CVH was positively associated with per capita county-level long term hospital beds, nursing home beds, and community mental health centers (rho/p-values respectively: 0.122/<0.0001; 0.062/p=0.003; 0.078/<0.0001) but negatively associated with per capita county-level beds in skilled nursing facilities, home health agencies and federally qualified health centers (rho/p-values respectively: -0.189/<0.0001; -0.086/<0.0001; -0.065/0.002). Further study is needed to understand the marginal impact of health care providers and facilities on county CVH.