Abstract P28: Awareness and Management of CVD Risk Factors and Area-Level Mortality Regions in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Abstract

Background: Federally designated Health Professional Shortage Areas (HPSA) receive extra resources, but recent reports suggest that HPSAs may not consistently identify areas of need. We examined an alternative approach to designating areas of need based on county-level ischemic heart disease (IHD) and stroke mortality rates. Methods: We examined participants in the REGARDS Study, a national cohort of 30,239 US community-dwelling adults (42% African Americans) aged ≥45 recruited 2003-7. “Need” was defined by awareness, treatment or control of hypertension (n=21,118), diabetes (6,355) or hyperlipidemia (21,096). Awareness and treatment were self-reported, and control was defined as BP <140/90 mmHg (<130/80 for diabetes or chronic kidney disease) for hypertension; fasting blood sugar <140 mg/dL (<200 if non-fasting) for diabetes; and LDL cholesterol <130 mg/dL for hyperlipidemia. Each county was categorized into race-specific tertiles of IHD and, separately, stroke mortality, using 1999-2006 CDC data (based on death certificates). Sociodemographics, health behaviors, physical functioning and insurance status were included in separate multivariable models describing the relationships between IHD and stroke mortality and each element of need. Results: Participants resided in 1821 US counties, 578 in the lowest IHD mortality tertile (597 for stroke), 628 in the medium (586), and 627 in the highest (638). Awareness and treatment of CVD risk factors were similar for residents in counties across IHD and stroke mortality tertiles, but control tended to be lower in counties in the highest mortality tertiles (Table). Conclusions: Research is needed to elucidate why some CVD risk factor control is worse in areas of high CVD mortality despite similar levels of awareness or treatment of disease between high and low mortality areas. High stroke and IHD mortality may be one way to designate areas of need for resource allocation… Table. Adjusted * OR (95% CI) for Residence in a County in the Highest vs. Lowest (ref) IHD and Stroke Mortality Tertiles, ** for Awareness, Treatment, and Control of Hypertension, Diabetes and Hyperlipidemia. Outcome Hypertension Diabetes Hyperlipidemia IHD Stroke IHD Stroke IHD Stroke Awareness 1.14 (0.97,1.35) 1.07 (0.90,1.28) 1.02 (0.78,1.34) 0.98 (0.73,1.31) 1.05 (0.94,1.17) 0.98 (0.87,1.10) Treatment 1.10 (0.85,1.43) 0.80 (0.61,1.04) 1.21 (0.96,1.52) 1.12 (0.88,1.42) 1.06 (0.94,1.20) 1.02 (0.90,1.15) Control 1.00 (0.89,1.12) 0.88 (0.78,0.99) 0.79 (0.64,0.96) 0.82 (0.64,1.05) 0.83 (0.70,0.98) 0.95 (0.80,1.14) * Adjusted for age, race, gender, education, income, urban/rural residence, alcohol/tobacco use, medication adherence, exercise, BMI, and functional status. ** Race-specific tertiles.