Abstract P373: A Comparison of Examination-Based and Self-Reported Cardiovascular Health Indicators Using Mississippi Delta Cardiovascular Health Examination Survey Preliminary Data and the Mississippi Behavioral Risk Factor Surveillance System

Abstract

Background: Cardiovascular disease (CVD) surveillance at the regional or local level is limited. The Behavioral Risk Factor Surveillance System (BRFSS) frequently provides the primary source of information on CVD and its risk factors at the population level. However, BRFSS data may be limited due to reliability of self-reported information, a lack of serologic and other objective measurements, and non-local level sampling frames. The Mississippi Delta Cardiovascular Health Examination Survey (CHES) is an ongoing CVD surveillance system in the 18-county Mississippi Delta, a predominately rural, disadvantaged region with some of the highest rates of CVD in the nation. Our objective was to compare prevalence estimates of self-reported CVD risk factors from the Mississippi BRFSS with examination-based measures of these risk factors from Delta CHES. Methods: Delta CHES uses an in-home data collection model to collect survey data, anthropometric measures and fasting blood specimens on a representative sample of adults ≥ 18 years of age living in the Mississippi Delta region. Preliminary examination data, collected between October 2012 and October 2013, from 484 Delta CHES participants were compared to weighted 2011 Mississippi BRFSS self-reported data from 1,187 respondents living in the Mississippi Delta region. Prevalence estimates and 95% confidence intervals (CI) were calculated for measures related to obesity, hypertension, dyslipidemia, diabetes, and smoking. In Delta CHES, dyslipidemia was defined as abnormal values for any cholesterol component or for triglycerides; hypertension was defined as systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg; obesity was defined as body mass index of ≥ 30.0 kg/m 2 ; current smoking was defined as serum cotinine level > 10.0 ng/mL; and diabetes was defined as plasma glucose ≥ 126 mg/dl or hemoglobin A1c ≥ 6.5%. For prevalence estimates, non-overlapping 95% CIs indicate statistical significance (at α=0.05). Results: Delta CHES provided a significantly greater prevalence estimate of obesity [53.5% (95% CI 48.9-58.1%) vs. 42.9% (95% CI 39.0-46.9%)], diabetes [24.4% (95% CI 20.3-28.5%) vs. 16.3% (95% CI 13.7-18.9%)] and smoking [30.4% (95% CI 26.0-34.9%) vs. 20.2% (95% CI 16.7-23.6%)] compared to BRFSS. Conversely, the prevalence of hypertension was significantly lower in Delta CHES compared to BRFSS [14.4% (95% CI 11.2-17.6%) vs. 51.8% (95% CI 47.9-55.8%)]. Conclusion: Objectively measured estimates from Delta CHES and self-reported measures from the Mississippi BRFSS differed for key CVD risk factors. These preliminary findings suggest self-reporting may have distorted past estimates of CVD risk factor rates in the Mississippi Delta region. Population-based CVD surveillance systems using examination-based measurements can provide perspective on routinely collected self-reports.