The burden of heart disease and stroke in the Big Sky State

2007·3.6 MB·English

by  Montana.Dept. of Public Health and Human Services

THE BURDEN OF HEART DISEASE AND STROKE
IN THE BIG SKY STATE
MMOONNTTAANNAA 22000077
ACKNOWLEDGEMENTS
This report was prepared by the Cardiovascular Health and Diabetes Programs,
Chronic Disease Prevention and Health Promotion Section, Public Health and
Safety Division, Montana Department of Public Health and Human Services. The
following individuals contributed and were involved in the development and prepa-
ration of this report: Carrie S. Oser, MPH; Dorothy Gohdes, MD; Todd S. Harwell,
MPH; Michael J. McNamara, MS; 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:
• Susan Cummings, BSN, CPHQ, Behavioral Risk Factor Surveillance
System (BRFSS) Coordinator, Public Health and Safety Division
• David Fulgham, PhD, Mortality Statistician, Office of Vital Statistics
• Bruce Schwartz, MA, MPA, Research Specialist, Office of Vital Statistics
• Billings Area Indian Health Service
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
• Montana Stroke Workgroup
Front cover painting: Runoff by Mike Chapman
Back cover photograph: Old Man of the Hills and Walling Reef, 2006 by Todd S. Harwell
PREFACE
This updated cardiovascular burden report is intended to complement Montana’s
2006-2010 Heart Disease and Stroke State Plan. The report provides a detailed
view of heart disease, stroke and cardiovascular risk factors in Montana. Although
the burden report identifies encouraging trends in cardiovascular disease mortality
for our state, it also highlights the growing prevalence of cardiovascular risk factors
in Montanans, particularly in American Indians.
I
EXECUTIVE SUMMARY
Cardiovascular Disease Mortality in Montana
In 2005, cardiovascular disease (CVD) remains the leading cause of death in
Montana with the majority of these deaths (30%) due to heart disease and stroke.
• Since 1979, cardiovascular disease age-adjusted mortality rates have fallen in
the US and in Montana by almost 42% and 55%, respectively.
• In 2005, heart disease and stroke were the second and fourth leading causes
of death. In comparison, in 2000, heart disease and stroke were the first and
third leading causes of death, respectively.
• Significant health disparities exist in Montana’s largest minority group, Ameri-
can Indians (AI). From 1990-2005, Montana American Indians experienced
higher age-adjusted mortality rates from CVD than non-Indians in the state.
Cardiovascular Risk Factors in Montana
• Montana American Indians’ prevalence of diabetes increased from 12% in
1999 to 19% in 2005. During the same timeframe, this population’s preva-
lence of high blood pressure rose from 26% to 37%. Montana American
Indians’ prevalence of obesity was almost twice that of all Montanans and US
adults from 1999 to 2005.
• From 1990 to 2005, the prevalence of high blood pressure rose from 19% to
24% for Montana adults. During that period, the prevalence of high blood
cholesterol among Montana adults rose from 25% to 33%. One out of five
Montana adults was obese in 2005.
Signs/Symptoms Awareness
• From 2003 to 2005, older Montana BRFSS respondents increased their
knowledge of four or more stroke and heart attack signs and symptoms.
Discharge Data
• Heart failure age-adjusted hospital discharge rates have increased from
2001 to 2005.
• Among Montana residents, age-adjusted stroke and coronary heart disease
hospital discharge rates decreased slightly from 2001 to 2005.
II
TABLE OF CONTENTS
Acknowledgements
Preface I
Executive Summary II
List of Figures IV, V
Introduction 1
Montana Demographics 2
Leading Causes of Death in Montana 3

MORTALITY 4
Cardiovascular Disease 4
Heart Disease 6
Coronary Heart Disease 6
Heart Failure 9
Stroke 11

MODIFIABLE CARDIOVASCULAR RISK FACTORS 14
Diabetes 15
High Blood Pressure 15
High Blood Cholesterol 16
Blood Cholesterol Screening 16
Obesity 17
Current Tobacco Use 17

SELF-REPORTED CARDIOVASCULAR DISEASE 18
Heart Attack 18
Stroke 18
Number of Cardiovascular Risk Factors 19
KNOWLEDGE OF HEART ATTACK AND STROKE SIGNS/

SYMPTOMS AND NEED TO CALL 9-1-1 20
Heart Attack Signs and Symptoms 20
Stroke Signs and Symptoms 21
Discussion and Conclusion 22
Appendix A – Methods, Data Sources and Limitations 23
Appendix B – Montana Counties 26
References 27
LIST OF FIGURES
PAGE
Figure 1 Map of Montana Indian reservations and type of county, 2005 2
Figure 2 Leading causes of death, Montana, 2005 3
Figure 3 Leading causes of death among Montana American Indians, 2005 3
Figure 4 Map of age-adjusted cardiovascular disease death rates, by county, 4
Montana, 1999-2005
Figure 5 Age-adjusted cardiovascular disease mortality rates for all Montanans 4
and the general US population, 1979-2005
Figure 6 Age-adjusted cardiovascular disease mortality for Montana and the 4
general US population, by gender, 1979-2005
Figure 7 Smoothed cardiovascular disease mortality rates, by race, 4
Montana, 1990-2005
Figure 8 Age-adjusted cardiovascular disease mortality rates for Montana, 5
by type of county, 1990-2005
Figure 9 Cardiovascular disease morality rates, by age and race, 5
Montana, 2000-2005
Figure 10 Leading causes of death, Montana, 2005 6
Figure 11 Map of age-adjusted coronary heart disease death rates, by county, 6
Montana 1999-2005
Figure 12 Age-adjusted coronary heart disease mortality rates for Montana 6
and the general US population, 1979-2005
Figure 13 Age-adjusted coronary heart disease mortality rates for Montana 6
and the general US population, by gender, 1979-2005
Figure 14 Smoothed coronary heart disease mortality rates, by race, 7
Montana, 1990-2005
Figure 15 Age-adjusted coronary heart disease mortality rates for Montana, 7
by type of county, 1990-2005
Figure 16 Coronary heart disease mortality rates, by age and race, 7
Montana, 2000-2005
Figure 17 Age-adjusted cardiovascular disease hospital discharge rates, 8
by type, Montana, 2001-2005
Figure 18 Age-specific coronary heart disease hospital discharge rates, 8
Montana, 2001-2005
Figure 19 Coronary heart disease hospital discharge rates, by gender and age, 8
Montana, 2005
Figure 20 Percentage of premature (less than 65 years) coronary heart disease 8
hospital discharges in Montana, by gender and type of county, 2005
Figure 21 Age-adjusted heart failure mortality rates for Montana and the general 9
US population, 1979-2005
Figure 22 Age-adjusted heart failure mortality rates for Montana and the general 9
US population, by gender, 1979-2005
Figure 23 Age-adjusted heart failure mortality rates for Montana, by type of county, 9
1990-2005
IV
Figure 24 Age-specific heart failure hospital discharge rates, Montana 2001-2005 10
Figure 25 Heart failure hospital discharge rates, by gender and age, Montana, 2005 10
Figure 26 Percentage of premature (less than 65 years) heart failure hospital 10
discharges in Montana, by gender and type of county, 2005
Figure 27 Map of age-adjusted stroke death rates, by county, Montana 1999-2005 11
Figure 28 Leading causes of death, Montana, 2005 11
Figure 29 Age-adjusted stroke mortality rates for Montana and the general US 11
population, 1979-2005
Figure 30 Age-adjusted stroke mortality rates for Montana and the general US 11
population, by gender, 1979-2005
Figure 31 Smoothed stroke mortality rates, by race, Montana, 1990-2005 12
Figure 32 Age-adjusted stroke mortality rates for Montana, by type of county, 12
1990-2005
Figure 33 Stroke mortality rates, by age and race, Montana, 2000-2005 12
Figure 34 Age-specific stroke hospital discharge rates, Montana, 2001-2005 13
Figure 35 Stroke hospital discharge rates, by gender and age, Montana, 2005 13
Figure 36 Prevalence of diabetes for all Montanans, Montana American Indians 15
and the US, 1990 to 2005
Figure 37 Prevalence of high blood pressure for all Montanans, Montana American 15
Indians and the US, 1990-2005
Figure 38 Prevalence of high blood cholesterol for all Montanans, Montana 16
American Indians and the US, 1990 to 2005
Figure 39 Prevalence of cholesterol screening (in past 5 years) for all Montanans, 16
Montana American Indians and the US, overall and for those 45 years
and older, 1990-2005
Figure 40 Prevalence of obesity for all Montanans, Montana American 17
Indians and the US, 1990 to 2005
Figure 41 Prevalence of current tobacco use for all Montanans, Montana 17
American Indians and the US, 1990-2005
Figure 42 Prevalence of Montana adults who reported having a heart attack or stroke, 18
by gender, 1999 to 2005
Figure 43 Prevalence of Montana American Indian adults who reported having a 18
heart attack or stroke, by gender, 1999 to 2005
Figure 44 Prevalence of Montana adults with self-reported cardiovascular risk factors, 19
by race, 1999 to 2005
Figure 45 Percentage responding correctly to questions about heart attack signs and 20
symptoms among Montana adults, by age, 2003 and 2005
Figure 46 Knowledge of heart attack signs and symptoms among Montana adults 65 20
years and older, 2003 and 2005
Figure 47 Knowledge of heart attack warning signs among adults 45 years and older 20
in Silver Bow and Flathead counties at baseline and follow-up, 2005
Figure 48 Percentage responding correctly to questions about stroke signs and 21
symptoms among Montana adults, by age, 2003 and 2005
Figure 49 Knowledge of stroke signs and symptoms among Montana adults 65 years 21
and older, 2003 and 2005
Figure 50 Knowledge of stroke warning signs among adults 45 years and older in 21
Cascade and Yellowstone counties at baseline and follow-up, 2004 and 2005
V

INTRODUCTION
Cardiovascular disease (CVD) is the leading cause of death in Montana. Many
Montanans have experienced a heart attack, heart failure or stroke, and many
others are at risk for serious but preventable cardiovascular disease. Public
health efforts to reduce the burden of cardiovascular disease are growing in the
state. The approaches include:
• promoting public awareness of risk factors and symptoms of heart
attack and stroke and the need to use 911
• coordinating care to reduce risk factors for both primary prevention
and prevention of recurrent events
• working with physician offices to improve hypertension and
lipid control
Surveillance related to cardiovascular disease in Montana gives the framework
for the comprehensive Cardiovascular Health Program and provides informa-
tion for all Montanans about progress in controlling the risk factors and reduc-
ing the morbidity and mortality in Montana. This document updates the 2003
Burden of Cardiovascular Disease in Montana and contains updated data from
a variety of sources. Policy makers, health care providers, emergency response
personnel, health department workers and many other individuals can use the
information contained in this update to guide activities and assess progress in
reducing cardiovascular disease in Montana communities.
1
MONTANA DEMOGRAPHICS
Montana is the fourth largest state in the United States but has a relatively small population. In 2005,
the estimated total population of Montana was 935,670 with a population density of approximately
6.4 persons per square mile. The median age was 40.2 years, 50% were women and 13% of Mon-
tana residents were 65 years of age or older. Of the 56 counties in Montana, 48 were defined as
“frontier” (non-metropolitan counties without a city of 10,000). The remaining eight counties were
defined as “small urban” counties with over 60% of the states’ population residing in these counties.
Over 90% of Montana’s population is white with approximately 6% of the population being American
Indian – Montana’s largest ethnic population. (Figure 1)
Over 62% of the population lives in one of eight counties. These counties, defined as “small urban,”
range in population from 16,304 to 136,691. A small urban county is a non-metropolitan county with
a city of > 10,000 population or a county in metropolitan areas with less than one million population.
(1) In contrast, the remaining 48 counties in Montana are defined as “frontier,” meaning a non-met-
ropolitan county without a city of 10,000 or more population. (1) In 2005, population estimates in the
frontier counties ranged from 470 to 39,940 with seven of these counties having fewer than 1,500
residents and 45 of these counties having a population density of six or fewer persons per square
mile. (2) This report compares trends in mortality between frontier and small urban counties.
Another important feature of Montana’s population is the economic characteristics of the state.
In 2005, the median household income for Montana was almost 15% less than the US, ($39,301
compared to $46,242) (2) although the median household income for Montana American Indians
was only $25,696 compared to $40,354 for the white population. In terms of wages, in 2003, eight of
the top 10 poorest counties in America were located in Montana’s frontier counties. (3) In 2005, the
Behavioral Risk Factor Surveillance System (BRFSS) found that 22% of all Montanans reported hav-
ing no health care coverage, and this rate of uninsured Montanans has increased steadily from 15%
in 2000. Unfortunately, the rate of uninsured Montana adults is seven percentage points higher than
the comparable national figure of 15%. (4) Uninsured adult Montanans were likely to be younger and
report lower income and less education than adults with health care coverage (data not shown).

[Note: The terms “small urban” and “frontier” are used in this document as general descriptors only.]
Figure 1. Map of Montana Indian reservations and type of county, 2005
Blackfeet
Rocky
Boy's
FortPeck
Fort
Belknap
Flathead
Northern
Cheyenne
Crow
Legend
Indianreservation
Smallurbancounty
Frontiercounty
Data source: Montana Department of Public Health and Human Services, Office of Vital Statistics
2