Table Of Content

The Burden of Cardiovascular Disease in the State of Montana 2003 Montana Department of Public Health and Human Services Cardiovascular Health Program 1 2 Cardiovascular Burden Report Preface To assist many agencies and reducing the health burden from communities in Montana, the coronary heart disease and stroke, the Montana Cardiovascular Health most common forms of Program issued the Montana cardiovascular disease. This report Cardiovascular Disease Prevention contains an in-depth picture of and Control Plan in 2000. As part of cardiovascular disease and its risk the five-year plan, the Cardiovascular factors. It compares the trends in Disease/Obesity Prevention Task Montana to the United States (US) as Force envisioned having Montana- a whole and to the Healthy People specific data to guide efforts in 2010 goals for the nation. 3 Acknowledgements This report was prepared by the Chronic Disease Prevention and Health Promotion Section, Cardiovascular Health, Nutrition/Physical Activity and Diabetes Unit, Health Policy and Services Division, Montana Department of Public Health and Human Services. The following individuals contributed and were involved in the preparation of this report: Carrie S. Oser, MPH; Dorothy Gohdes, MD; Todd S. Harwell, MPH; Lynda Blades, MPH, CHES; Crystelle Fogle, MBA, MS, RD; and Steven D. Helgerson, MD, MPH The authors would like to give special thanks to the following individuals and organizations for their technical support and contributions to this report: • Joanne Oreskovich, PhD, BRFSS Coordinator, Montana Department of Public Health and Human Services • David Fulgham, PhD, Mortality Statistician, Office of Vital Statistics, Montana Department of Public Health and Human Services • Billings Area Indian Health Service • Dick Dodge, Dodge Data Systems • Kurt Greenlund, Epidemiologist, Centers for Disease Control and Prevention We acknowledge the following organizations for their continued support of the Cardiovascular Health Program: • American Heart Association • Centers for Disease Control and Prevention • Montana Cardiovascular Disease/Obesity Prevention Task Force 4 Executive Summary Cardiovascular Disease Mortality in Montana In 2000, Cardiovascular Disease (CVD) remained the leading cause of death in Montana with over 30% of all deaths attributed to heart disease (24.6%) and stroke (7.2%). Heart disease • Heart disease death rates were higher in the US than in Montana from 1990-2000, but in Montana, death rates did not decrease as rapidly over the and stroke decade. mortality • Stroke deaths rates for both Montana and the US were similar and declined at the same rate from 1990-2000. declined • From 1990-2000, Montana’s American Indians had a much smaller over the decrease in CVD deaths compared to the US and Montana as a whole. The heart disease death rate among Indians in Montana actually surpassed that last decade, of the US population during the decade. but hypertension Stroke death rates decreased 12% in Montana’s sparsely populated frontier counties and almost 9% in the small urban counties from 1990-2000. Heart prevalence disease deaths also declined less rapidly (15%) in Montana’s small urban is increasing. counties compared to the frontier counties (23%). Cardiovascular Disease Risk Factors in Montana • In 2001, over a quarter (26.8%) of all Montana adults reported a history of high blood pressure. Reported high blood pressure rates increased 8% in the past decade. • Montana’s American Indians reported having diabetes almost three times more often than all Montanans and the general US population in 2001. In addition, Indians with diabetes were five times more likely to have had a heart attack than those without diabetes. • Montanans aged 65 or older are at higher risk for a heart attack or stroke, but they were less likely than younger adults to recognize all the symptoms of heart attack and stroke according to a recent survey. • Montana high school students (9th – 12th grade) were less likely to eat at least 5 servings of fruits and vegetables a day (17.6% vs. 21.4%) compared to the US. 5 6 Table of Contents Preface................................................................................................................3 Acknowledgements ............................................................................................4 Executive Summary............................................................................................5 List of Figures.....................................................................................................8 Introduction ......................................................................................................10 Leading Causes of Death in Montana and the US............................................11 Montana Demographic Information.................................................................12 Mortality for Cardiovascular Disease A. Cardiovascular Disease .......................................................................13 B. Heart Disease.......................................................................................15 C. Stroke...................................................................................................17 Modifiable Cardiovascular Risk Factors A. Obesity.................................................................................................21 B. Overweight..........................................................................................21 C. Physical inactivity ...............................................................................22 D. Poor dietary habits...............................................................................22 E. Current tobacco use.............................................................................23 F. Diabetes...............................................................................................23 G. High blood pressure.............................................................................24 H. High blood cholesterol ........................................................................24 I. Blood cholesterol screening (in past 5 years)......................................25 Knowledge of Signs and Symptoms of Heart Attack and Stroke.....................26 Self-Reported Cardiovascular Disease.............................................................28 CVD Hospitalizations for Montana Medicare beneficiaries ............................30 Secondary Prevention of Heart Disease in Montana........................................31 Modifiable Cardiovascular Factors among Montana’s Youth..........................32 Discussion and Conclusion...............................................................................35 Appendix A – Methods, Data Sources and Limitations ...................................36 Appendix B – Montana Counties.....................................................................40 References ........................................................................................................41 7 List of Figures Figure 1 Leading causes of death in Montana in 2000................................11 Figure 2 Leading causes of death in the United States in 2000. .................11 Figure 3 Map of small urban and frontier counties in Montana..................12 Figure 4 Age-adjusted cardiovascular disease mortality rates for all Montanans, Montana American Indians and the general US population. 1990-2000..................................................................13 Figure 5 Age-adjusted cardiovascular disease mortality rates for the US and Montana, by sex. 1990-2000.........................................................14 Figure 6 Age-adjusted cardiovascular disease mortality rates for small urban and frontier counties in Montana and the general US population. 1990-2000.....................................................................................14 Figure 7 Age-adjusted heart disease mortality rates for all Montanans, Montana American Indians and the general US population. 1990-2000.....................................................................................15 Figure 8 Age-adjusted heart disease mortality rates for the US and Montana, by sex. 1990-2000.........................................................................15 Figure 9 Age-adjusted heart disease mortality rates for small urban and frontier counties in Montana and the general US population. 1990-2000.....................................................................................16 Figure 10 Age-adjusted stroke mortality rates for all Montanans, Montana American Indians and the general US population. 1990-2000.....17 Figure 11 Age-adjusted stroke mortality rates for the US and Montana, by sex. 1990-2000..............................................................................17 Figure 12 Age-adjusted stroke mortality rates for small urban and frontier counties in Montana and the general US population. 1990-2000.....18 Figure 13a Proportion of adults, in Montana and the US, reporting cardiovascular disease behavior risk factors, including Healthy People 2010 goals. 2001 a) Current smoker, diabetes, high blood cholesterol and high blood pressure.........................................................................................20 Figure 13b b) Obesity, physical inactivity and poor dietary habits.................20 Figure 14 Trends in prevalence of obesity among all Montanans, Montana American Indians and the US. 1990-2001....................................21 Figure 15 Trends in prevalence of overweight among all Montanans, Montana American Indians and the US. 1990-2001.....................21 Figure 16 Trends in prevalence of physical inactivity among all Montanans and the US. 1990-2001 .................................................................22 Figure 17 Trends in prevalence of inadequate 5 A Day consumption among all Montanans and the US. 1990-2001..........................................22 Figure 18 Trends in prevalence of current tobacco use for all Montanans, Montana American Indians and the US. 1990-2001....................23 Figure 19 Trends in prevalence of diabetes for all Montanans, Montana American Indians and the US. 1990-2001....................................23 8 Figure 20 Trends in prevalence of high blood pressure for all Montanans, Montana American Indians and the US. 1990-2001.....................24 Figure 21 Trends in prevalence of high blood cholesterol for all Montanans, Montana American Indians and the US. 1990-2001.....................24 Figure 22 Trends in prevalence of cholesterol screening (in past 5 years) for all Montanans, Montana American Indians and the US. 1990-2001.....................................................................................25 Figure 23 Prevalence of heart attack signs and symptoms awareness among Montana adults. 2001....................................................................26 Figure 24 Prevalence of correct responses to questions about heart attack signs and symptoms among Montana adults, by age. 2001..........26 Figure 25 Prevalence of stroke signs and symptoms awareness among Montana adults. 2001....................................................................27 Figure 26 Prevalence of correct responses to questions about stroke signs and symptoms among Montana adults, by age. 2001...................27 Figure 27 Proportion of Montana adults who report ever having a heart attack or stroke. 1999-2001...........................................................28 Figure 28a Proportion of Montana adults who report ever having a heart attack, 1999-2001. a) by sex........................................................28 Figure 28b b) American Indians by diabetes status. 1999 and 2001..............28 Figure 29a Proportion of Montana adults who report ever having a stroke, 1999-2001. a) by sex.....................................................................29 Figure 29b b) American Indians by diabetes status. 1999 and 2001...............29 Figure 30 Incidence of AMI hospitalizations among Montana Medicare beneficiaries, by year of admission, by sex, 1995-2000...............30 Figure 31 Incidence of AMI hospitalizations among Montana Medicare beneficiaries, by year of admission, by age. 1995-2000...............30 Figure 32 Incidence of AMI hospitalizations among Montana Medicare beneficiaries, by year of admission, by diabetes discharge diagnosis. 1995. ............................................................................30 Figure 33a Percent of Medicare beneficiaries with an AMI receiving secondary prevention services, 1998-2000. a) ASA admission, ASA discharge, B-blocker admission, B-blocker discharge.........31 Figure 33b Percent of Medicare beneficiaries with an AMI receiving secondary prevention services. 1998-2000. b) ACE-I discharge and smoking cessation. ................................31 Figure 34 Proportion of adolescents (9th – 12th grade) in Montana and the US, reporting CVD risk factors in 2001 and Healthy People 2010 goals. 2001...........................................................................32 Figure 35 Percent of Montana adolescents’ (9th – 12th grade) perception about their weight, by BMI classification. 2001...........................33 Figure 36 Percent of Montana adolescents’ (9th – 12th grade) weight management goals, by BMI classification. 2001..........................33 9 Introduction Cardiovascular disease (CVD) is the The purpose of this report is to leading cause of death in the United highlight information that describes States and in the state of Montana. the burden of heart disease and stroke The yearly Behavior Risk Factor and their associated risk factors in Surveillance System (BRFSS) Montana. Using data from the Office provides a valuable surveillance of Vital Statistics, BRFSS and a mechanism to assess trends in many special American Indian BRFSS as important cardiovascular risk factors, well as Medicare hospitalization and mortality statistics describe the claims for Montana residents, this magnitude and relative importance of report presents data on the mortality heart disease and stroke in Montana. from cardiovascular disease, heart Overall, disease incidence and disease, and stroke along with recent mortality vary by geographic location trends. In addition, information and ethnicity. Mortality from about the prevalence and trends in cardiovascular disease declined selected modifiable cardiovascular within the US, but after 1990, the risk factors are presented, along with rates of decline slowed.(1) Risk information about how well adults in factors for heart disease and stroke Montana recognize the signs and remain highly prevalent, but the symptoms of heart disease and patterns vary in Montana’s stroke. populations. Public health efforts to reduce cardiovascular disease must Note: Full methods on sources and focus on priority populations and limitations are located in Appendix A target the broad social and – Methods, data sources and environmental factors that influence limitations. knowledge, attitudes and behaviors that contribute to the burden of heart disease in Montana. 10