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. 2009 Aug-Sep;49(2-3):129-32.
doi: 10.1016/j.ypmed.2009.03.004. Epub 2009 Mar 11.

Advancing the hypothesis that geographic variations in risk factors contribute relatively little to observed geographic variations in heart disease and stroke mortality

George Howard  1 , Mary Cushman, Ronald J Prineas, Virginia J Howard, Claudia S Moy, Lisa M Sullivan, Ralph B D'Agostino Sr, Leslie A McClure, Leavonne Pulley, Monika M Safford
Affiliations

Advancing the hypothesis that geographic variations in risk factors contribute relatively little to observed geographic variations in heart disease and stroke mortality

George Howard et al. Prev Med. 2009 Aug-Sep.

Abstract

Purpose: Geographic variation in risk factors may underlie geographic disparities in coronary heart disease (CHD) and stroke mortality.

Methods: Framingham CHD Risk Score (FCRS) and Stroke Risk Score (FSRS) were calculated for 25,770 stroke-free and 22,247 CHD-free participants from the REasons for Geographic And Racial Differences in Stroke cohort. Vital statistics provided age-adjusted CHD and stroke mortality rates. In an ecologic analysis, the age-adjusted, race-sex weighted, average state-level risk factor levels were compared to state-level mortality rates.

Results: There was no relationship between CHD and stroke mortality rates (r=0.04; p=0.78), but there was between CHD and stroke risk scores at the individual (r=0.68; p<0.0001) and state (r=0.64, p<0.0001) level. There was a stronger (p<0.0001) association between state-level FCRS and state-level CHD mortality (r=0.28, p=0.18), than between FSRS and stroke mortality (r=0.12, p=0.56).

Conclusions: Weak associations between CHD and stroke mortality and strong associations between CHD and stroke risk scores suggest that geographic variation in risk factors may not underlie geographic variations in stroke and CHD mortality. The relationship between risk factor scores and mortality was stronger for CHD than stroke.

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Figures

Figure 1
Figure 1
a: Relationship of age adjusted 2003-2005 stroke mortality rate and CHD mortality rate for ages 45+ for all 50 states (r = 0.04, p = 0.78)
Figure 1
Figure 1
b: Relationship of age adjusted 2003-2005 stroke mortality rate and CHD mortality rate for ages 45+ for the 25 states included in the analysis (r = -0.11, p = 0.61).
Figure 2
Figure 2
Relationship between average CHD and average stroke risk (r = 0.64, p < 0.0001)
Figure 3
Figure 3
a: Relationship of average Framingham CHD Score and CHD mortality rate at the state level (r = 0.28; p = 0.18)
Figure 3
Figure 3
b: Relationship of average Framingham Stroke Score and stroke mortality rate at the state level (r = 0.12, p = 0.56)
See this image and copyright information in PMC

Comment in

References

    1. Centers for Disease Control National Health and Nutrition Examination Survey (NHANES) 1999-2002. 2004. http://www.cdc.gov/nchs/nhanes.htm.
    1. Centers for Disease Control CDC BRFSS Prevalance and Trends Data. Source: http://apps.nccd.cdc.gov/BRFSS/index.asp. Retrieved February 2009.
    1. CDC Wonder System http://wonder.cdc.gov/mortSQL.html. Retrieved June 2008.
    1. Cushman M, Cantrell RA, McClure LA, Howard G, Prineas RJ, Moy CS, Temple EM, Howard VJ. Estimated 10-year stroke risk by region and race in the United States. Ann Neurol. 2008;64:507–513. - PMC - PubMed
    1. D’Agostino RB, Wolf PA, Belanger AJ, Kannel WB. Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study. Stroke. 1994;25(1):40–43. - PubMed

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