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Heart DISEASE and STROKE

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Heart DISEASE and STROKE THE MARYLAND BURDEN OF Heart DISEASE AND STROKE Maryland Department of Health & Mental Hygiene Family Health Administration Office of Chronic Disease Prevention 2009 Data Review Martin O’Malley Governor Anthony G. Brown Lt. Governor John M. Colmers Secretary Department of Health and Mental Hygiene Russell Moy, M.D., M.P.H. Director Family Health Administration Joan H. Salim Deputy Director Family Health Administration Audrey S. Regan, Ph.D. Director Office of Chronic Disease Prevention Maria Prince, M.D., M.P.H. Medical Director Office of Chronic Disease Prevention Discrimination Policy: The services and facilities of the Maryland Department of Health and Mental Hygiene (DHMH) are operated on a non-discriminatory basis. This policy prohibits discrimination on the basis of race, color, sex or national origin and applies to the provisions of employment and granting of advantages, privileges, and accommodations. The Department, in compliance with the Americans with Disabilities Act, ensures that qualified individuals with disabilities are given an opportunity to participate in and benefit from DHMH services, programs, benefits, and employment opportunities. Acknowledgements: This report was prepared by the Office of Chronic Disease Prevention at the Maryland Department of Health and Mental Hygiene with funding provided through a Cooperative Agreement with the Centers for Disease Control and Prevention, Division of Heart Disease and Stroke Prevention (UDP000749-02). TABLE OF CONTENTS Executive Summary …………………………………………………………………. 5 Burden of Heart Disease in Maryland …………………………………..................... 6 Heart Disease Prevalence ……………………………………………………. 6 Heart Disease Mortality ………………...…………….…………………….. 10 Heart Disease Hospitalization Data …………………………………………. 13 Burden of Stroke in Maryland ………………………………………………………. 17 Stroke Prevalence …………………………………………………………… 17 Stroke Mortality ……………………………………………………………... 19 Stroke Hospitalization Data …………………………………………………. 21 Heart Disease, Stroke and Related Risk Factors …………………………………..... 24 Maryland Heart Disease and Stroke Prevention Program …………………………... 27 Appendix A: Data Sources ………………………………………………………….. 28 Appendix B: Definitions ……………………………………………………………. 30 Appendix C: Disease Diagnosis ……………………………………………….……. 32 EXECUTIVE SUMMARY Heart disease and stroke are the numbers one and three causes of death for Maryland residents. The public health impact of heart disease and stroke is substantial, both in terms of disease burden and cost. In 2008, an estimated $1.2 billion of adult medical expenditures in Maryland were attributable to heart disease and stroke (Maryland Health Services Cost Review Commission). Coronary heart disease (angina or/and heart attack) and stroke are linked to higher prevalence rates, high hospitalization rates, and high mortality. Controlling risk factors such as high blood pressure, high blood cholesterol and diabetes play an important role in heart disease and stroke prevention. In 2008, over half (63.4%) of Maryland residents were overweight and obese and high blood pressure was a common co-occurring condition among residents who have experienced heart attack or stroke (Maryland BRFSS). SPECIAL POPULATIONS It was estimated from 2005 to 2008 that heart disease and stroke affected certain segments of the population disproportionately based on race and ethnicity, gender, age, and education and income levels. Angina and heart attack were most prevalent among white males. The prevalence of coronary heart disease has increased the most among white males and black females. Coronary heart disease and stroke were most prevalent among Maryland adults aged 55 and over, with a lower household income ($15k-25k), and with less education. Black Marylanders had almost twice the age-adjusted hospital discharge rate for heart failure, non-specific chest pain, and stroke than white Marylanders. Black Marylanders had nearly 5-6 times the hypertension rate of white Marylanders. Black males experienced the highest levels of age-adjusted death associated with coronary heart disease, hypertensive heart disease and stroke. Data sources, disease definitions and disease diagnosis can be found in Appendix A-C (pp29- 32). RECOMMENDATIONS This Burden Report is released in conjunction with the Maryland Heart Disease and Stroke Prevention and Control Plan (The 5 Year Plan), a joint publication of the Maryland Department of Health and Mental Hygiene and the Governor’s Heart Disease and Stroke Prevention Council. The five year Plan identifies specific recommendations, activities and partners to improve the morbidity and mortality associated with cardiovascular disease and stroke in Maryland. Sources utilized in this report include data from the Behavioral Risk Factor Surveillance System (BRFSS), the Maryland Health Services Cost Review Commission and the Maryland Vital Statistics Administration. 5 BURDEN OF Heart DISEASE IN MARYLAND Coronary Heart Disease Prevalence This report discusses prevalence as it refers to coronary heart disease (angina or/and heart attack) as defined by the Maryland Behavior Risk Factor Surveillance System (Maryland BRFSS, 2005- 2008, since 2009 is not available). This section highlights differences in coronary heart disease prevalence based on race and ethnicity, gender, age, education and income levels from 2005 to 2008. The overall prevalence of angina in Maryland has increased from 3.7 percent in 2005 to 4.4 percent in 2008 (Figure 1). Prevalence remains highest in white males (6.5 percent) and lowest in black females (3.3 percent, Figure 1). Figure 1. Prevalence of Angina in Maryland, Overall and by Gender/Race, 2005-2008 Source: Maryland BRFSS 10.0 8.0 6.0 4.0 Percentage 2.0 0.0 2005 2006 2007 2008 Overall 3.7 4.5 3.9 4.4 White Males 5.4 6.8 6.5 6.5 White Females 3.6 3.9 2.5 3.7 Black Males 3.4 4.8 2.4 4.1 Black Females 2.1 3.7 3.5 3.3 Year Prevalence of heart attack in Maryland has increased overall and across all races/genders from 2005 to 2008 (Figure 2) with the exception of white females and black males. The prevalence of heart attack for white males increased from 4.7 percent in 2005 to 6.7 percent in 2008 (Figure 2). 6 Figure 2. Prevalence of Heart Attack in Maryland, Overall and by Gender/Race, 2005-2008 Source: Maryland BRFSS 10.0 8.0 6.0 4.0 Percentage 2.0 0.0 2005 2006 2007 2008 Overall 3.6 4.3 3.4 3.9 White Males 4.7 6.2 4.8 6.7 White Females 3.2 3.3 2.5 2.7 Black Males 4.1 6.2 4.2 3.4 Black Females 2.6 3.6 3.1 3.2 Year Coronary heart disease prevalence in Maryland was the highest among white males, and increased from 7.4 percent in 2005 to 9.4 percent in 2008(Figure 3). Prevalence of coronary heart disease has also increased among black females, moving from 3.8 percent in 2005 to 5 percent in 2008 (Figure 3). Figure 3. Prevalence of Coronary Heart disease in Maryland, Overall and by Gender/Race, 2005-2008 Source: Maryland BRFSS 12.0 10.0 8.0 6.0 4.0 Percentage 2.0 0.0 2005 2006 2007 2008 Overall 5.6 6.7 5.7 6.3 White Males 7.4 9.8 8.3 9.4 White Females 5.2 5.4 4.1 5.1 Black Males 5.6 7.8 5.0 5.9 Black Females 3.8 5.8 5.1 5.0 Ye ar 7 Maryland residents ages 55 and over compromised the highest prevalence of coronary heart disease from 2005 to 2008 (Figure 4). Residents with less than a high school education experiences more than three times the prevalence of heart disease (14.7 percent) compared to those that attainted a college level education (4.1 percent). The prevalence of coronary heart disease decrease as income level increases. Maryland residents earning less than $25,000 per year experience almost four times the prevalence of coronary heart disease than those making more than $75,000 per year (Figure 5). In 2005-2008, the Somerset county had the highest prevalence of heart attack, three times the state average prevalence at 3.8% (Map 1) and Allegany county had the highest prevalence of angina (9%) and twice the state average prevalence at 4.1% (Map 2). Figure 4. Prevalence of Coronary Heart Disease in Maryland by Age, 2005-2008 (4 Year Average) Source: Maryland BRFSS 25.0 22.8 20.0 15.3 15.0 9.1 10.0 Percentage 6.4 5.0 2.0 0.9 0.0 25-34 35-44 45-54 55-64 65-74 75+ Age Figure 5. Prevalence of Coronary Heart Disease in Maryland, by Education and Income, 2005-2008 (4 Year Average) Source: Maryland BRFSS 20.0 14.7 15.0 15.0 12.6 10.0 7.3 7.9 Percentage 4.1 4.7 5.0 3.3 0.0 < High High College <$15K $15K- $25K- $50k- $75k School School 24.9K $49.9K $74.9K Education Income 8 Map 1. Percent of Residents Ever Told by a Doctor They Had a Heart Attack (Myocardial Infarction), 2005-2008 (4 Year Average) Source: Maryland BRFSS Map 2. Percent of Residents Ever Told by a Doctor They Had Angina, 2005-2008 (4 Year Average) Source: Maryland BRFSS 9 Heart Disease Mortality Of all types of heart disease, coronary heart disease had the highest mortality in Maryland (Figure 6a). The overall age-adjusted death rate attributable to coronary heart disease has declined between 2005 and 2008 from 166.5 to 147.1 deaths per 100,000 population. The largest reduction took place among white females and black females (Figure 6b). The age-adjusted death from coronary heart disease is disproportionately highest among black males at 239.3 (Figure 6b). In 2008, Seven of Maryland’s twenty-four jurisdictions had mortality of coronary heart disease that were above the Healthy People 2010 goal of reducing age-adjusted death rate associated with coronary heart disease to 166 per 100,000 populations (Table 1). Black males had the highest mortality of hypertensive heart disease (Figure 6c).
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