Abstract P001: State-Level Trends in Cardiovascular Health, 2003-2011
BACKGROUND: Cardiovascular disease is the leading cause of death in the United States, so improving cardiovascular health (CVH) is a key population health goal. As part of public health efforts to achieve this, the American Heart Association recently developed a comprehensive CVH index that incorporates smoking, body mass index, physical activity, diet, cholesterol, blood pressure, and blood glucose. OBJECTIVE: The objective of the current study was to investigate the change in CVH in each of the U.S. states using Behavioral Risk Factor Surveillance System (BRFSS) data between 2003 and 2011. A secondary objective was to assess the impact of 2011 methodological changes to BRFSS on CVH. METHODS: Data from the Behavioral Risk Factor Surveillance System were used to determine calculate CVH for each state for 2003, 2005, 2007, 2009, and 2011. Federal Information Processing Standards codes were used to obtain age-standardized mean CVH for each state. The main outcomes were age-standardized mean CVH score and prevalence of each component. Time trends for each state were determined using by including a time variable corresponding to the BRFSS study year in a Poisson model for total CVH and logistic models for individual CVH components. Differences in total CVH and prevalence of components between 2003 and 2009 as well as between 2009 and 2011 were calculated and Pearson chi square tests were used to determine significant differences. RESULTS: Overall the age-standardized mean CVH index was 3.73 for 2003, 3.71 for 2005, 3.68 for 2007, 3.65 for 2009, and 3.45 for 2011. In 2011, CVHI ranged from a high of 3.70 in Colorado to a low of 3.15 in West Virginia and Mississippi. The majority of states in the U.S. had both a decline in mean CVH and an increase in the prevalence of poor CVHI between 2003 and 2009. Overall, the prevalence of ideal smoking behavior increased from 79.2% to 83.5% and the prevalence of ideal diet increased from 12.1% to 13.4%. The prevalence of ideal for all other components decreased; blood pressure by 4.2 percentage points, cholesterol by 5.9, blood glucose by 1.4, and physical activity by 12.2. Comparing the magnitude of absolute differences in CVHI between 2003 and 2009 with 2009 and 2011, many of the one year changes (09 to 11) were greater than the six year changes (03 to 09). CVH has decreased in a linear fashion between 2003 and 2009 likely due to decreases during this time in ideal blood pressure, cholesterol, and BMI. CONCLUSIONS: This data can be used to inform state specific risk factor targets that would be most effective in improving overall CVH. The large differences seen due to 2011 BRFSS methodological changes raise concerns for states that rely on this data to evaluate programs and target resources.
Author Disclosures: C. Pilkerton: None. S. Singh: None. A. Christian: None. T.K. Bias: None. S.J. Frisbee: None.
- © 2015 by American Heart Association, Inc.