The Burden of Cardiovascular Disease in Virginia

1
The Burden of Cardiovascular Disease in Virginia

• Stephanie Gruss,
• Epidemiologist
• Virginia Department of Health
• April 14, 2005
• Work [phone]

Stephanie.Gruss_at_vdh.virginia.gov
2
Critical Issues- Chronic Disease is Costly

• Seven of every 10 U.S. residents who die each
  year (1.7 million persons) do so as a result of
  a chronic disease.
• Chronic diseases are the most preventable causes
  of death.
• Chronic diseases affect the quality of life of 90
  million U.S. residents.
• The cost of medical care for persons with these
  diseases accounts for 70 of total medical care
  expenditures.

Source http//www.cdc.gov/mmwr/preview/mmwrhtml/r
r5311a1.htm
3
Critical Issues- Heart Disease in the U.S.

• Heart disease is the leading cause of death for
  both women and men in the U.S.
• In 2001, 700,142 people died of heart disease
  (52 women 48 men), accounting for 29 of all
  U.S. deaths.
• Heart disease is the leading cause of death for
  American Indians and Alaska Natives, blacks,
  Hispanics, and whites. Although cancer is the
  leading cause of death for Asians and Pacific
  Islanders (accounting for 26.4 of all deaths),
  heart disease is a close second (25.4). 
• At the end of 2004, heart disease cost 238.6
  billion, including health care services,
  medications, and lost productivity. 

Source http//www.cdc.gov/cvh/maps/methods/dataso
urces.htm
4
Critical Issues- State Level

• Cardiovascular disease- CVD (heart disease
  stoke) is the number one killer of Virginians
• 14,881 people in Virginia died from heart disease
  and 3,938 died from stroke in 2002 this is more
  than died from cancer, injuries, and diabetes
  combined
• Planning District 2- Buchanan County, Dickenson
  County, Russell County, and Tazwell County had a
  heart disease death rate of 317 per 100,000
  population- the highest in the state
• Planning District 1- Lee County, Scott County,
  Wise County, and Norton City had the
  second-highest rate at 278 per 100,000

Source VDH, Center for Health Statistics, 2004
5
VA Population by Race and Ethnicity, 2002
Source U.S. Bureau of Census Center for Health
Statistics- VDH, 2003
6
Deaths Due to Cardiovascular Disease
7
Causes of Death in VA, 2002
Source VDH, Center for Health Statistics, 2004
8
Cardiovascular Deaths in Virginia, 2002
Source VDH, Center for Health Statistics, 2004
9
CVD Deaths and Gender

• The decline of CVD deaths in Virginia is less for
  women than men - between 1995 and 2002 the number
  of CVD deaths decreased 6 for men but only 1
  for women.
• Although stroke mortality rates are similar for
  men and women, women are more likely to have a
  stroke at a younger age (40s or 50s) and are more
  likely to die from stroke.
• Nationally, women account for more than 60 of
  the annual deaths due to stroke, making it the
  second leading cause of death among American
  women.

Sources VDH, Center for Health Statistics, 2004
http//www.cdc.gov/mmwr/
10
CVD Deaths and Race/Ethnicity

• Virginia 2002 age-adjusted CVD mortality rates
  are significantly higher for blacks (384.4) than
  whites (295.3).
• White females had the highest non-age-adjusted
  CVD mortality rate in 2002 at 306.7 per 100,000
  population, followed secondly by black females at
  282.3.
• For Hispanics in Virginia, there were only 300
  deaths due to CVD in years 2001 2002, combined.
  

Source VDH, Center for Health Statistics, 2004
11
CVD Deaths and Age

• In Virginia, about 31 of all CVD deaths were to
  individuals ages 75-84, across gender and race
• Almost 10 of all CVD deaths were to individuals
  ages 55-64
• Both white and black females had the highest
  percentage of CVD deaths occurring in the 85 and
  up age range
• Both white and black males had the highest
  percentage of CVD deaths occurring in the 75-84
  age range
• About 14.3 of all CVD deaths occurred before age
  55

Source VDH, Center for Health Statistics, 2004
12
Total CVD Death Rates by Gender Race

• In Virginia in 2002, males had a higher
  age-adjusted mortality rate per 100,000
  population than females
• Both white males and black males had higher
  age-adjusted rates than their female counterparts

(N 20,126)
Source VDH, Center for Health Statistics, 2004
13
Stroke Death Rates by Gender Race

• In Virginia in 2002, males had a higher
  age-adjusted stroke mortality rate per 100,000
  population than females
• White males and females had similar stroke
  mortality rates
• Black males had a higher age-adjusted stroke
  mortality rate than their female counterparts

(N 3,938)
Source VDH, Center for Health Statistics, 2004
14
Other Diseases of the Heart Death Rates by Gender
Race

• In Virginia in 2002, males had a higher
  age-adjusted DOH mortality rate per 100,000
  population than females
• Both white males and black males had a higher
  age-adjusted DOH mortality rate than their female
  counterparts

(N 4,814)
Source VDH, Center for Health Statistics, 2004
15
Heart Attack Death Rates by Gender Race

• In Virginia in 2002, males had a higher
  age-adjusted heart attack mortality rate per
  100,000 population than females
• Both white males and black males had higher
  age-adjusted heart attack mortality rates than
  their female counterparts

(N 9,534)
Source VDH, Center for Health Statistics, 2004
16
BUT, look at the actual counts for VA for
2002
Females die with greater frequency than males
in every CVD category except heart attack.
Source VDH, Center for Health Statistics, 2004
17
Risk Factors Associated with Cardiovascular
Disease
18
Risk Factors and CVD, VA
Five A Day is recommended
In 2002, 75.4 of males ate less than the
recommended amount per day, as compared to 68.8
of females, and 76.0 of Blacks ate less than
recommended as compared to 72.3 of Whites.
74.2
2003
Source http//apps.nccd.cdc.gov/brfss/Trends/
19
Consumption of Fruits Vegetables, VA 2001-2003
Source VCU, SERL, BRFSS Analysis Aggregated
years 2001-2003
20
Risk Factors and CVD, VA
Reported in 30 Days
In 2002, 28.3 of females reported no physical
activity as compared to 20.2 of males, and
35.7 of Blacks reported no physical activity as
compared to 21.5 of Whites.
24.4
Source http//apps.nccd.cdc.gov/brfss/Trends/
21
Physical Activity, VA 2001-2003
Source VCU, SERL, BRFSS Analysis Aggregated
years 2001-2003
22
Risk Factors and CVD, VA
Overweight Body Mass Index (BMI) 25-29
35.1
Source http//apps.nccd.cdc.gov/brfss/Trends/
23
Risk Factors and CVD, VA
Obese (BMI) over 30
In 2002, males (25.0) were slightly more obese
than females (22.5), and Blacks (34) were more
obese than Whites (22.4) rates decreased with
increasing education level.
23.7
Source http//apps.nccd.cdc.gov/brfss/Trends/
24
BMI, VA 2001-2003
Source VCU, SERL, BRFSS Analysis Aggregated
years 2001-2003
25
Risk Factors and CVD, VA
The good news! More people than ever before are
having their cholesterol checked.
17.9
2003
Source http//apps.nccd.cdc.gov/brfss/Trends/
26
Risk Factors and CVD, VA

• In 2002, high cholesterol rates in males (35.1)
  were slightly higher than females (32.3) and
  rates were higher among Whites (34.6) than
  Blacks (27.4).

Sources Virginia BRFSS Core Modules Report, 2003
http//apps.nccd.cdc.gov/brfss/Trends/
27
High Cholesterol, VA 2001-2003
Source VCU, SERL, BRFSS Analysis Aggregated
years 2001-2003
28
Risk Factors and CVD, VA
Rates are slightly higher among females (26.6)
than males (24.3), and higher among Blacks
(31.5) than Whites (24.5).
Source BRFSS State Data Report, Virginia 2003,
VDH
29
Hypertension, VA 2001-2003
Source VCU, SERL, BRFSS Analysis Aggregated
years 2001-2003
30
Risk Factors and CVD, VA
Source http//apps.nccd.cdc.gov/brfss/Trends/
31
Risk Factors and CVD, VA
18-34 year olds have the highest smoking
prevalence rates.
31.4
Source http//apps.nccd.cdc.gov/brfss/Trends/
32
Risk Factors and CVD, VA
Source BRFSS State Data Report, Virginia 2003,
VDH
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Hospitalizations and Cardiovascular Disease
34
Critical Issues- Cost of CVH at State Level

• TOTAL Virginia CVH Hospitalization Costs, 2002
• Primary diagnosis of cardiovascular disease-
  2,546,432,363
• Any Diagnosis of cardiovascular disease-
  14,875,546,605

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Hospitalizations Due to CVD, VA 2002
Source VHI Dataset, 2004 Diseases of the Heart
ICD-9 405 409, 418, 419 (for hospitalization
data purposes per http//www.cdc.gov/cvh/maps/meth
ods/datasources.htm)
36
Hospitalizations Due to CVD, VA 2002
Source VHI Dataset, 2004
37
Hospitalizations Due to CVD, VA 2002
Source VHI Dataset, 2004
38
Hospitalizations Due to CVD, VA 2002
Source VHI Dataset, 2004
39
CVD Hospital-izations by Region, VA 2002
5
2
1
4
ALLEGHANY
3
Source VHI Dataset, 2004
40
Cardiovascular Disease and Diabetes
41
CVD and Co-morbidity with Diabetes

• Diabetes is an independent risk factor for
  several types of CVD coronary heart disease,
  stroke, peripheral artery disease,
  cardiomyopathy, and congestive heart failure.
• People with diabetes are two to four times more
  likely to have a heart attack or stroke than
  people without diabetes.
• People with diabetes are more likely to die from
  a second heart attack than people with CVD who do
  not suffer from diabetes.

Source http//www.ndep.nih.gov/control/CVD.htm
42
CVD and Co-morbidity with Diabetes

• Total number of CVD hospital discharges in
  Virginia in 2002 (any diagnosis) was 827,116
• Of those 827,116 CVD discharges, 29.53 were
  persons with diabetes
• About 10 of all CVD deaths in Virginia in 2002
  were to people with diabetes
• A secondary diagnosis of CVD is found in about
  75 of all diabetes-coded deaths.

Source VHI Dataset, 2004
43
CVD and Co-morbidity with Diabetes
Cardiovascular Disease Deaths with Diabetes
Listed as Contributing Cause, Virginia 2002
Source Center for Health Statistics, VDH, 2004
44
Where Can One Find Local-level Data?

• BRFSS sample size is too small to calculate risk
  factor rates by locality (i.e. individual city or
  county)
• For locality-level rates for some hospital
  discharges and census data (demographic and
  economic) with a mapping program go to
  http//www.vahealthycommunities.com/default.asp,
  and click on Virginia ATLAS of Community Health
  to access the free, ATLAS database
• For a free mapping program displaying heart
  disease and stroke death rates per locality go
  to http//www.cdc.gov/cvh/maps/statemaps.htm,
  and click on Go to state maps
• For age-adjusted death rates per county for
  Virginias leading causes of death go to
• http//www.vdh.state.va.us/healthstats/DeathsByAg
  e02.pdf