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. 2014 Jul 8;9(7):e101531.
doi: 10.1371/journal.pone.0101531. eCollection 2014.

Interstate variation in modifiable risk factors and cardiovascular mortality in the United States

Shivani A Patel  1 , K M Venkat Narayan  1 , Mohammed K Ali  1 , Neil K Mehta  1
Affiliations

Interstate variation in modifiable risk factors and cardiovascular mortality in the United States

Shivani A Patel et al. PLoS One. .

Abstract

Objective: We investigated the role of state-level differences in modifiable cardiovascular (CV) risk factors in contributing to state disparities in cardiovascular mortality rates in the US.

Methods: Adults aged 45-74 in 2010 were examined. We constructed a CV risk index summarizing state-level exposure to current smoking, obesity, physical inactivity, alcohol abstinence, hypertension, elevated cholesterol, and diabetes using the Behavioral Risk Factor Surveillance System. Outcomes were cardiovascular, coronary heart disease, and stroke mortality. Linear regression was used to estimate associations between the CV risk index and mortality outcomes. Models accounted for state-level socioeconomic characteristics and other potential confounders.

Results: Risk factors were highly correlated at the state-level (Cronbach's alpha 0.85 (men) and 0.92 (women). Each +1SD difference in the cardiovascular risk index was associated with higher adjusted cardiovascular mortality rates by 41.0 (95%CI = 26.3, 55.7) and 33.3 (95%CI = 24.4, 42.2) deaths per 100,000 for men and women, respectively. The index accounted for 8% (men) and 11% (women) of the variation in state-level cardiovascular mortality. Comparable associations were also observed for coronary heart disease and stroke mortality.

Conclusions: CV risk factors were highly correlated at the state-level and were independently associated with state CV mortality, suggesting the utility of generalized CV risk reduction.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Geographical distribution of quintiles of state-level CV risk index among men (panel A) and women (panel B) aged 40–69 y in 2005 in the US.
The CV risk index is a composite measure computed from principal components analysis of state-level risk factor prevalence data.
See this image and copyright information in PMC

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