Differences between Arkansas and the United States in Prevalence of Risk Factors Explain Variations in Ischemic Heart Disease Mortality Rates among Pre-Medicare (45-64) and Medicare (65-84) Age Groups

Robert Delongchamp,Appathurai Balamurugan,Joseph Bates,Abby Holt,Namvar Zohoori,Gordon Reeve,M F Faramawi

doi:10.29333/ejeph/5838

Abstract

Arkansas (AR) consistently has higher ischemic heart disease (IHD) death rates than the US, which is believed to be due to a higher prevalence in AR of major, modifiable risk factors. We examined the difference in IHD death rates between AR and the US as consequences of differences in the prevalence of nine risk factors between pre-Medicare age group (45-64) and Medicare age group (65-84). We modeled IHD deaths attributable to differential prevalence between AR and the US using mortality data and prevalence data from AR and US for years 2000-2010, and relative risk measures obtained from the INTERHEART and Atherosclerosis Risk in Communities studies. From 2000-2010, our study showed that if we were to reduce the prevalence of significant risk factors to US levels, we would reduce AR IHD deaths by 26.6% in the pre-Medicare age group and 15.9% in the Medicare age group. Most of the increased mortality was explained by higher prevalence of smoking and hypertension in AR. Other socioeconomic factors that contributed to an increased risk of poor health outcomes were education, income, and the lack of health insurance; with AR having worse outcomes than the US for the pre-Medicare age group. The importance of risk factors depended on race, sex, and age. The excess mortality in AR relative to the US for the two age groups can largely be explained by prevalence differences in smoking, hypertension, cholesterol, education and income.

Highlights

Death rates from heart disease in the United States (US) and Arkansas (AR) have declined rapidly since the 1970s, the burden remains high (Centers for Disease Control and Prevention, 2013; Gillespie et al, 2013; Go et al, 2014)
We investigated the contribution of the differences, between Arkansas and US, in the prevalence of major, modifiable risk factors, including health insurance, in pre-Medicare (45-64 years of age) and Medicare (65-84 years of age) age groups, to explore the effects that such reductions could have on the excess ischemic heart disease (IHD) mortality in Arkansas
The relative risk and excess absolute risk increased over the years with the exception of black women

Summary

Introduction

Death rates from heart disease in the United States (US) and Arkansas (AR) have declined rapidly since the 1970s, the burden remains high (Centers for Disease Control and Prevention, 2013; Gillespie et al, 2013; Go et al, 2014). In 2013, heart disease was the leading cause of death in the US and AR with ischemic heart disease (IHD) contributing the majority of these deaths (Centers for Disease Control and Prevention, 2014). AR has substantially higher IHD death rates than the US (Centers for Disease Control and Prevention, 2014). Major modifiable risk factors for heart disease have been extensively studied and elucidated. Their contribution to the excess mortality of high-burden states have not.

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Conclusion