the risk of heart disease and stroke in alabama: burden ...alabamapublichealth.gov/cardio/assets/2009_Heart... · Although heart disease and stroke are largely preventable, these

the risk of heart diseaseand stroke in alabama:burden document

table of contents

executive Summary ................................................................................................................. 1

demographic characteristics of Alabama ................................................................................. 2

Leading causes of death ......................................................................................................... 3

Introduction ............................................................................................................................ 4

cardiovascular disease ........................................................................................................... 5

Heart disease ......................................................................................................................... 8

Stroke ................................................................................................................................... 11

cardiovascular risk Factors: High blood Pressure ................................................................. 14

cardiovascular risk Factors: High blood cholesterol .............................................................. 16

cardiovascular risk Factors: diabetes ................................................................................... 18

cardiovascular risk Factors: overweight and obesity ............................................................. 20

cardiovascular risk Factors: Smoking ................................................................................... 22

cardiovascular risk Factors: Physical Inactivity ..................................................................... 24

cardiovascular risk Factors: Fruit and Vegetable consumption .............................................. 26

Signs and Symptoms of Heart Attack or Stroke ...................................................................... 28

references ........................................................................................................................... 29

1

executive summary

In Alabama, as in the nation, cardiovascular disease (cVd), which includes heart disease and stroke, is the leading cause of death.

Heart disease, the most common form of cardiovascular disease, is the single leading cause of death in Alabama. In 2005, 12,869 people died from heart disease in the state. men have a higher age-adjusted heart mortality rate than women. coronary heart disease, the most common type of heart disease, can result in heart attack, which can be prevented by modifying risk factors.

cerebrovascular accident (cVA), known as stroke, is the third leading cause of death in Alabama, following heart disease and cancer. In 2005, 4,942 people died from a stroke. compared to heart disease, race is a better predictor of death from stroke than gender, with blacks having higher mortality rates than whites.

modifiable risk factors for heart disease and stroke highlighted in this report are:1. high blood pressure;2. blood cholesterol;3. diabetes;4. overweight and obesity;5. smoking;6. physical inactivity; and7. fruit and vegetable consumption.

one in three adults in Alabama is affected by high blood pressure, sometimes called the “silent killer” because it usually has no noticeable warning signs or symptoms. High blood cholesterol can lead to blocked blood vessels, and 39.4 percent of Alabama adults reported they were diagnosed with high blood cholesterol in 2007. diabetes is a disease with elevated blood glucose which increases the risk for heart disease and stroke. Since 1997, the prevalence of diagnosed diabetes has increased by 48 percent in Alabama. overweight and obese individuals are more likely to have risk factors for heart disease and stroke, and in Alabama, 66.6 percent of adults are overweight and obese. Smoking more than doubles their risk for heart disease and stroke, and 22.5 percent of adults are current smokers. Physical inactivity also increases the risk for heart disease and stroke, and 29.8 percent of adults were physically inactive. reduced consumption of fresh fruits and vegetables daily increases the risk for heart disease and stroke, and only 20.6 percent met the recommended requirements.

Focusing on prevention efforts can help reduce deaths from heart disease and stroke by:1. reducing risk factors;2. increasing public awareness of warning signs and symptoms of heart attack and stroke; and3. decreasing the time between the appearance of any warning signs and symptoms and when a

person receives appropriate medical care.

Although heart disease and stroke are largely preventable, these diseases continue to result in high mortality rates. this report provides details about this burden by describing the mortality rates and risk factors associated with heart disease and stroke.

2

demoGraPhics

table 1: demoGraPhic characteristics of alabama 2007

AL (#) AL (%) u.S.

total PoPulation 4,287,768 299,398,485

male 2,078,914 48.4 49.2%

Female 2,208,854 51.6 50.8%

median aGe (years) 35.6 (x) 36.4

under 5 years 301,198 6.7 6.8%

18 years and over 3,198,771 75.6 75.4%

65 years and over 522,874 13.4 12.4%

one race 4,246,242 98.9 98.0%

White 2,760,233 70.3 73.9%

black or African-American 1,356,981 26.3 12.4%

American Indian or Alaska native 24,018 0.5 0.8%

Asian 57,084 1.0 4.4%

Some other race 47,211 0.8 6.3%

two or more races 41,526 1.1 2.0%

Hispanic or Latino (of any race) 123,281 2.5 14.8%

civilian veterans (civilian population 18 years and over) 324,880 11.8 10.4%

disability status (population 5 years and over) 729,191 20.3 15.1%

Foreign born 125,204 2.9 12.5%

male, married, except separated (population 15 years and over) 811,237 54.5 52.4%

Female, married, except separated (population 15 years and over) 793,075 48.8 48.4%

Speak a language other than english at home (population 5 years and over) 336,509 4.2 19.7%

Source: united States census bureau, 2007

3

fiGure 1: leadinG causes of death in alabama 2005

• CardiovasculardiseaseistheleadingcauseofdeathanddisabilityinAlabama.

• HeartdiseaseistheprimarycauseofdeathinAlabamaandkillsover12,000 residents each year.

• 27.3percentofthedeathsinAlabamawereduetoheartdiseaseand6.3 percent were due to stroke in 2005.

• Strokeisthethirdleadingcauseofdeath,killingnearly5,000peopleeach year.

Source: cdc Wonder

cancer21.1%

stroke6.3%

heartdisease27.3%

all other causes37.2%

diabetes3.0%

accidents & adverse

effects5.1%

4

60.9

349.3

400

350

300

250

200

150

100

50

0

rate

Pe

r 1

00

,00

0

year20051999 2000 2001 2002 2003 2004

396.6

71.5 71.5 66.1 69.5 64.9 63.1

264.5

303.0299.5 289.7 285.7 280.9

269.3

393.7 379.8 377.7370.6

355.7

fiGure 2: aGe-adjusted mortality rates for cardiovascular disease, heart disease, and stroke in alabama 1999-2005

strokecardiovascular disease heart disease

Source: centers for disease control and Prevention. retrieved from http://www.cdc.gov

cardiovascular disease (cVd) refers to a wide variety of heart and blood vessel diseases, including ischemic heart disease, hypertension, stroke, and rheumatic heart disease. cVd accounts for more deaths in Alabama than any other cause of death. While cVd remains the number one threat as cause of death for Alabamians, many adults do not recognize the signs and symptoms of heart attack or stroke. most victims surviving a heart attack or stroke often require long-term, expensive medical treatment and experience a compromised quality of life. refer to Figure 2 for observation of decreasing trends in mortality rates for cardiovascular disease, heart disease, and stroke in Alabama.

introduction

5

year

fiGure 3: aGe-adjusted death rate for cardiovascular disease in alabama and the united states 1999-2005

400

350

300

250

200

150

100

50

0

1999 2000

rate

Pe

r 1

00

,00

0

2001 2002 2003 2004 2005

396.6

350.8341.4

328.2319.0

307.7

288.0278.9

393.7 379.8 377.7370.6

355.7349.3


alabama united states

cardiovascular disease (cVd), a preventable disease, includes conditions of the heart, arteries, and veins that supply oxygen to vital life-sustaining areas of the body like the brain, the heart, and other vital organs. If oxygen does not arrive, the tissue or organ will die. In Alabama, as in the nation, cardiovascular disease, including heart disease and stroke, is the leading cause of death. About one-third of adult Americans have some form of cVd.

• Cardiovasculardiseaseage-adjusteddeathratesinAlabamaexceededthecomparableratesfortheUnitedStatesoverthepast ten years.

• In2005,theage-adjusteddeathrateforAlabamawas349.3per100,000population,adecreasefrom396.6 in1999.(Figure 3)

cardiovascular disease

6

fiGure 4: cardiovascular deaths by aGe GrouP in alabama 2005

• Ageisanon-modifiableriskfactorforCVD.ThenumberofCVDdeathsincreaseswithage.• DeathsfromCVDoccurredmoreofteninthoseovertheageof75years.• NearlyoneoutoffourdeathsfromCVDoccurredinthosebelowtheageof65in2005.(Figure4)

Source: cdc Wonder

6000

5000

4000

3000

2000

1000

0<45 45-54 55-64 65-74 75-84 85+

627

1,200

2,056

2,802

5,0275,277

fiGure 5: aGe-adjusted death rates for cvd by Gender and race in alabama 2005

• In2005,theage-adjusteddeathratewashighestamongblackmales(502.6/100,000population).• MaleswereatahigherriskofdyingduetoCVDthanfemalesin2005.(Figure5)

Source: cdc Wonder

600

500

400

300

200

100

0male female

502.6

385.8

123.2

363.1

289.1

131.5

otherwhiteblack

aGe in years

Gender

nu

mb

er

of d

eath

sr

ate

Pe

r 1

00

,00

0

LAUDERDALE

LAWRENCE

LIMESTONE

MORGAN

CULLMAN

MARSHALLDEKALB

CHEROKEE

CALHOUN

CLEBURNE

RANDOLPHCLAY

TALLADEGA

COOSATALLAPOOSA

CHAMBERS

ETOWAH

BLOUNT

ST. CLAIR

SHELBY

JEFFERSON

LAMARFAYETTE

TUSCALOOSA

BIBB

GREENE

SUMTER

CHOCTAW

MARENGO

HALE

PERRY

DALLAS

WILCOX

LOWNDES

AUTAUGA

CHILTON

ELMORE

MONTGOMERY

MACON

BULLOCK

PIKE

CRENSHAW

BUTLER

CONECUH

MONROE

CLARKE

WASHINGTON

BALDWIN

COVINGTON

ESCAMBIA

MOBILE

COFFEEDALE

BARBOUR

HENRY

HOUSTONGENEVA

RUSSELL

LEE

PICKENS

JACKSONMADISON

COLBERT

FRANKLIN

MARION WINSTON

WALKER

7

deaths/100,000, age-adjusted to 2000 population

Source: cdc Wonder

fiGure 6: cardiovascular disease mortality rate in alabama by county 1999-2005 (combined)

359.7

309375.1

411.2

449.4

330.8

419.7

415436.7400.2419.4

430

394.2

469.7376.1

404.3

367.8418.4

426.5

452

435.2406.8

421.8 429.2 372.5 385.7 423.6

365.3

422.8

347.6

328.1

406.1

448.6

450.1

352.7

304.8

389.6

394.1

444.7

479.8

390.3

365.2

490.3

356.4404.9

350.1382.6

368.2

410

368.9

395.7

373.5

441.8 281.7

395.2

440.3

350.7

356.1

398.5437.2

411.1344.2

404.09

377.7

401.5

418.2

327.2

cVd mortality rate281.7 - 365.3367.8 - 395.7398.5 - 419.7421.8 - 490.3

8

Heart disease is a grouping of various conditions of the heart including coronary heart disease, congestive heart failure, heart attack, hypertension, and others. It is the leading cause of death for both men and women. more than 600,000 deaths occur each year in the united States. It is the most common form of cVd and can cause angina (chest pain), heart attacks (myocardial infarction), and cardiac arrest. many times, a heart attack is the first sign of heart disease.

• In2005,theage-adjustedmortalityrateforheartdiseasewas264.5per100,000populationinAlabamaand211.1per100,000 population in the united States.

• DeathrateswereconsistentlyhigherforthestateofAlabamafrom1999to2005comparedtonationalrates.(Figure7)

fiGure 7: aGe-adjusted death rate for heart disease in alabama and the united states 1996-2005

Source: cdc Wonder

300

250

200

150

100

50

0

266.4257.6

247.8 240.8232.3

217.0 211.1

303.0 299.5 289.7 285.7 280.9269.3

264.5

united statesalabama

20051999 2000 2001 2002 2003 2004

heart disease

year

rate

Pe

r 1

00

,00

0

9

fiGure 8: heart disease deaths by aGe GrouP in alabama, 2005

• Deathsfromheartdiseaseincreasedwithage.• Atotalof12,869peoplediedfromheartdiseaseinAlabamaduring2005.• 25percentofthedeathsoccurredinthosebelowtheageof65years.(Figure8)

Source: cdc Wonder

4000

3000

2000

1000

0<45 45-54 55-64 65-74 75-84 85+

500

957

1,620

2,114

3,7343,944

fiGure 9: aGe-adjusted death rates for heart disease by Gender and race in alabama 2005

• In2005,theage-adjustedmortalityrateforheartdiseasewashighestamongblackmaleswitharateof 373.0 per 100,000 population.

• Riskofdeathfromheartdiseasewashigheramongmalescomparedtofemales.(Figure9)

Source: cdc Wonder

400

300

200

100

0male female

373.0

309.6

252.6

214.2

whiteblack

aGe in years

Gender

nu

mb

er

of d

eath

sr

ate

Pe

r 1

00

,00

0

10

fiGure 10: heart disease mortality rate in alabama by county 1999-2005 (combined)

LAUDERDALE

LAWRENCE

LIMESTONE

MORGAN

CULLMAN

MARSHALLDEKALB

CHEROKEE

CALHOUN

CLEBURNE

RANDOLPHCLAY

TALLADEGA

COOSATALLAPOOSA

CHAMBERS

ETOWAH

BLOUNT

ST. CLAIR

SHELBY

JEFFERSON

LAMARFAYETTE

TUSCALOOSA

BIBB

GREENE

SUMTER

CHOCTAW

MARENGO

HALE

PERRY

DALLAS

WILCOX

LOWNDES

AUTAUGA

CHILTON

ELMORE

MONTGOMERY

MACON

BULLOCK

PIKE

CRENSHAW

BUTLER

CONECUH

MONROE

CLARKE

WASHINGTON

BALDWIN

COVINGTON

ESCAMBIA

MOBILE

COFFEEDALE

BARBOUR

HENRY

HOUSTONGENEVA

RUSSELL

LEE

PICKENS

JACKSONMADISON

COLBERT

FRANKLIN

MARION WINSTON

WALKER

286.0

227.7286.3

324.1

357.4

248.8

338.1

342.9343.6317.6246.8

330.4

322.5

393.2285.9

305.3

268.7342.1

323.8

373.7

335.8269.8

292.3 332.6 281.2 292.2 313.7

276.6

338.7

272.5

247.1

316.4

382.2

358.3

274.8

230.8

289.8

291.8

351.1

385.3

306.7

288.8

404.5

283.3271.3

234.1294.3

285.1

311.6

268.7

291.7

275.3

335.4 194.9

298.2

347.5

248.4

285.8

307.9347.0

333.6277.3

316.8

297.8

326.1

320.9

240.9

Heart disease mortality rate194.9 - 275.3276.6 - 294.3297.8 - 330.4332.6 - 404.5


Source: cdc Wonder

11

fiGure 11: aGe-adjusted death rate for stroke in alabama and united states 1999-2005


80

70

60

50

40

30

20

10

0

1999 2000 2001 2002 2003 2004 2005

71.5 71.5

66.169.5

64.9 63.160.961.6 60.9

57.956.2

53.550.0

46.6


cerebrovascular accident (cVA), more commonly known as stroke, is the third leading cause of death in Alabama, following only heart disease and cancer. A stroke occurs when a blood vessel in or near the brain is blocked or bursts, interrupting the flow of blood to the brain. this causes lack of oxygen and causes brain cells to die. there are two primary types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs when there is a blockage of a blood vessel that is supplying the brain. A hemorrhagic stroke occurs when a blood vessel ruptures or leaks in or around the brain. the most common cause of stroke is ischemic stroke, the blockage of an artery in the brain by a clot.

• ThestrokemortalityratehasdeclinedoverthepastfewyearsbothinAlabamaandtheUnitedStates.

• Age-adjustedmortality rateswere60.9per100,000population forAlabamaand46.6per100,000population for theunited States in 2005. (Figure 11)

stroke

year

rate

Pe

r 1

00

,00

0

12

fiGure 12: stroke deaths by aGe GrouP in alabama 2005

•Deathsfromstrokeoccurredmoreofteninthoseovertheageof65.• 4,942deathsoccurredfromstrokein2005.(Figure12)

fiGure 13: aGe-adjusted death rates for stroke by Gender and race in alabama 2005

• In2005,blackmalesshowedthehigheststrokedeathrateof86.4per100,000populationfollowedby black females with the rate of 79.5 per 100,000 population.

• Forstroke,raceisabetterpredictorofdeaththangenderwiththeblackracebeingathigherriskthan whites. (Figure 13)

Source: cdc Wonder

100

80

60

40

20

0male female

86.4

53.3

79.5

55.7

whiteblack

Source: cdc Wonder

1000

800

600

400

200

0<45 45-54 55-64 65-74 75-84 85+

91

178

303

469

949 962

aGe in years

Gender

nu

mb

er

of d

eath

sr

ate

Pe

r 1

00

,00

0

Stroke mortality rate49.9 - 58.759.2 - 65.766.6 - 71.671.8 - 114.7

13

fiGure 14: stroke mortality rate in alabama by county 1999-2005 (combined)

LAUDERDALE

LAWRENCE

LIMESTONE

MORGAN

CULLMAN

MARSHALLDEKALB

CHEROKEE

CALHOUN

CLEBURNE

RANDOLPHCLAY

TALLADEGA

COOSATALLAPOOSA

CHAMBERS

ETOWAH

BLOUNT

ST. CLAIR

SHELBY

JEFFERSON

LAMARFAYETTE

TUSCALOOSA

BIBB

GREENE

SUMTER

CHOCTAW

MARENGO

HALE

PERRY

DALLAS

WILCOX

LOWNDES

AUTAUGA

CHILTON

ELMORE

MONTGOMERY

MACON

BULLOCK

PIKE

CRENSHAW

BUTLER

CONECUH

MONROE

CLARKE

WASHINGTON

BALDWIN

COVINGTON

ESCAMBIA

MOBILE

COFFEEDALE

BARBOUR

HENRY

HOUSTONGENEVA

RUSSELL

LEE

PICKENS

JACKSONMADISON

COLBERT

FRANKLIN

MARION WINSTON

WALKER

57.1

65.768.2

69.9

64.8

61

64.5

55.277.968.351.8

82.3

56.1

59.466.6

77.6

69.955.3

323.8

58.7

73114.7

107.1 70 64.6 62.3 94

71.6

61.9

56.6

57.9

67.9

54.4

69

59.3

51.5

63.9

68.7

81.9

75.5

67.4

57.7

63.8

51.693.1

53.570.5

63.5

77.9

78.3

88.2

69.7

81.9 67.3

77.2

69.8

77

49.9

71.867.8

61.853.7

56.2

60.9

59.2

80.6

65.3


Source: cdc Wonder

14

• TheprevalenceofhighbloodpressureinAlabamahascontinuouslyincreasedfrom24.8percentto33.1percentbetween1995 to 2007. the prevalence has consistently remained above the national average.

• MorethanoneinthreeadultsinAlabamareportedhavinghighbloodpressurein2007.(Figure15)

fiGure 15: Prevalence of rePorted hiGh blood Pressure in alabama and the united states 1995-2007

2007

33.1

27.5

40

30

20

10

0

1995 1997 1999 2001 2003 2005

24.8

28.931.2 31.6 33.1 31.2

22.2

23.024.0 25.6 24.8 25.5


• MaleshadasimilarprevalenceofhighbloodpressurecomparedtofemalesinAlabama.• Therewasasignificantincreaseofreportedhighbloodpressurewithincreasingage.• Blackshadahigherprevalenceofhighbloodpressurethanwhites.(Figure16)

fiGure 16: Prevalence of rePorted hiGh blood Pressure in alabama 2007 by Gender, aGe, and sex

black

37.6%32.0%

80

60

40

20

0male female

32.9% 33.3%

white18-24

5.6%

25-34

13.6%

35-44

24.3%

45-54

38.3%

55-64

52.0%

65+

59.9%

High blood pressure or hypertension is common in the united States, with at least one in three individuals being at risk of developing it. there are often no symptoms to signal high blood pressure. Lowering blood pressure by changes in lifestyle or by medication can lower the risk of heart disease and heart attack.

cardiovascular risk factors: hiGh blood Pressure

year

Pe

rc

en

tP

er

ce

nt

Source: Alabama brFSS


15

fiGure 17: PercentaGe of adults with hiGh blood Pressure in alabama by Public health area 2007

LAUDERDALE

LAWRENCE

LIMESTONE

MORGAN

CULLMAN

MARSHALLDEKALB

CHEROKEE

CALHOUN

CLEBURNE

RANDOLPHCLAY

TALLADEGA

COOSATALLAPOOSA

CHAMBERS

ETOWAH

BLOUNT

ST. CLAIR

SHELBY

JEFFERSON

LAMARFAYETTE

TUSCALOOSA

BIBB

GREENE

SUMTER

CHOCTAW

MARENGO

HALE

PERRY

DALLAS

WILCOX

LOWNDES

AUTAUGA

CHILTON

ELMORE

MONTGOMERY

MACON

BULLOCK

PIKE

CRENSHAW

BUTLER

CONECUH

MONROE

CLARKE

WASHINGTON

BALDWIN

COVINGTON

ESCAMBIA

MOBILE

COFFEEDALE

BARBOUR

HENRY

HOUSTONGENEVA

RUSSELL

LEE

PICKENS

JACKSONMADISON

COLBERT

FRANKLIN

MARION WINSTON

WALKER

area

11

area

9 area

10

area

8

area

7

area

3

area

4area

6

area

5

area

2area

1

36%29%

38%

32%40%

31%

32%

36%

33%

32%

36%


38.3 39.4

27.3 28.8

33.2 32.9

36.0

16

• MaleshadsimilarratescomparedtofemalesforhighbloodcholesterolinAlabama.• Thehighbloodcholesterolrateincreasedwithincreasingageandthenshowednearlythesamereadingsofagegroup55-64

compared to the 65 and older group.• Amongtheraceandethnicgroups,whitesreportedhavingthehighestrateof41.8percent.(Figure19)

fiGure 19: Prevalence of rePorted hiGh blood cholesterol in alabama 2007 by Gender, aGe, and race

black

33.0%

41.8%

80

60

40

20

0male female

38.3%40.0%

white18-24

7.8%

25-34

22.0%

35-44

30.1%

45-54

39.6%

55-64

53.7%

65+

54.2%

• Almost39.4percentofAlabamaadults reported theywerediagnosedwithhighbloodcholesterol in2007,while37.5percent were reported in the united States during the same time period.

• TheprevalencerateforhighbloodcholesterolwasconsistentlyhigheramongAlabamaresidentscomparedtothenationalaverage rates starting to be seen in 1999-2007. (Figure 18)

fiGure 18: Prevalence of rePorted hiGh blood cholesterol in alabama and the united states 1995-2007

20072005

35.637.5

40

30

20

10

0

1995 1997 1999 2001 2003

28.1 28.030.1 30.3

33.1


cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body. the body needs some cholesterol to work properly, but too much in your blood can stick to the walls of the arteries causing problems with the circulation of blood. this is called plaque; plaque can narrow the arteries or even block them. High levels of cholesterol in the blood can increase the risk of heart disease. to travel in the bloodstream, cholesterol is carried in small packages called lipoproteins. there are two types of cholesterol in the body, low-density lipoprotein (LdL), sometimes called bad cholesterol, and high-density lipoprotein (HdL), sometimes called good cholesterol.

cardiovascular risk factors: hiGh blood cholesterol

year

Pe

rc

en

tP

er

ce

nt



17

LAUDERDALE

LAWRENCE

LIMESTONE

MORGAN

CULLMAN

MARSHALLDEKALB

CHEROKEE

CALHOUN

CLEBURNE

RANDOLPHCLAY

TALLADEGA

COOSATALLAPOOSA

CHAMBERS

ETOWAH

BLOUNT

ST. CLAIR

SHELBY

JEFFERSON

LAMARFAYETTE

TUSCALOOSA

BIBB

GREENE

SUMTER

CHOCTAW

MARENGO

HALE

PERRY

DALLAS

WILCOX

LOWNDES

AUTAUGA

CHILTON

ELMORE

MONTGOMERY

MACON

BULLOCK

PIKE

CRENSHAW

BUTLER

CONECUH

MONROE

CLARKE

WASHINGTON

BALDWIN

COVINGTON

ESCAMBIA

MOBILE

COFFEEDALE

BARBOUR

HENRY

HOUSTONGENEVA

RUSSELL

LEE

PICKENS

JACKSONMADISON

COLBERT

FRANKLIN

MARION WINSTON

WALKER

area

11

area

9 area

10

area

8

area

7

area

3

area

4area

6

area

5

area

2area

1

43%39%

36%

33%39%

35%

35%

45%

45%

41%

44%

fiGure 19: PercentaGe of adults with hiGh cholesterol in alabama by Public health area 2007


18

• Theprevalenceofadultsdiagnosedwithdiabeteswassimilarinmalesandfemales.• Therewasasignificantincreaseinthepercentageofdiabeticswithanincreaseinage.• Theprevalenceofdiabeteswasgreateramongblacksthanwhites.(Figure22)

fiGure 22: Prevalence of adult diaGnosed with diabetes in alabama 2007 by Gender, aGe, and race

black

12.5%

9.6%

20

15

10

5

0male female

10.1% 10.4%

white18-24

0.8%

25-34

4.3%

35-44

5.6%

45-54

9.7%

55-64

19.0%

65+

21.0%

• Theprevalenceofself-reporteddoctordiagnoseddiabetesamongadultshasincreasedby48percentforAlabamaand47percent for the united States from 1998 to 2007.

• In2007,thepercentageofadultsdiagnosedwithdiabetesinAlabamawas2.3percentagepointshigherthanthenationalprevalence.

• TheprevalencewasconsistentlyhigherforAlabamafrom1998-2007comparedtotheUnitedStates.(Figure21)

fiGure 21: Prevalence of adult diaGnosed diabetes in alabama and the united states 1998-2007

10

8

6

4

2

0

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

7.0 7.4 7.4

9.6

8.5 8.78.1

9.7 9.910.3

5.4 5.4

6.16.4 6.7

7.2 7.1 7.3 7.58.1


diabetes is a disease in which the body does not produce or properly use insulin. there are 23.6 million children and adults in the united States, or 7.8 percent of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, 5.7 million people are unaware they have the disease. there are two major types of diabetes. type 1 diabetes results from the body’s failure to produce insulin, and type 2 diabetes results from insulin resistance, a condition in which the body fails to properly use insulin, combined with relative insulin deficiency.

cardiovascular risk factors: diabetes

year

Pe

rc

en

tP

er

ce

nt



19

LAUDERDALE

LAWRENCE

LIMESTONE

MORGAN

CULLMAN

MARSHALLDEKALB

CHEROKEE

CALHOUN

CLEBURNE

RANDOLPHCLAY

TALLADEGA

COOSATALLAPOOSA

CHAMBERS

ETOWAH

BLOUNT

ST. CLAIR

SHELBY

JEFFERSON

LAMARFAYETTE

TUSCALOOSA

BIBB

GREENE

SUMTER

CHOCTAW

MARENGO

HALE

PERRY

DALLAS

WILCOX

LOWNDES

AUTAUGA

CHILTON

ELMORE

MONTGOMERY

MACON

BULLOCK

PIKE

CRENSHAW

BUTLER

CONECUH

MONROE

CLARKE

WASHINGTON

BALDWIN

COVINGTON

ESCAMBIA

MOBILE

COFFEEDALE

BARBOUR

HENRY

HOUSTONGENEVA

RUSSELL

LEE

PICKENS

JACKSONMADISON

COLBERT

FRANKLIN

MARION WINSTON

WALKER

area

11

area

9 area

10

area

8

area

7

area

3

area

4area

6

area

5

area

2area

1

12%11%

10%

8%14%

10%

8%

13%

9%

12%

11%

fiGure 23: PercentaGe of adults with diabetes in alabama by Public health area 2007


20

black

75.5%

63.7%

fiGure 25: Prevalence of overweiGht and obese in alabama 2007 by Gender, aGe, and race

• TheprevalenceamongmaleswassignificantlyhigherthanfemalesinAlabama.• Overweightandobesityincreasedwithanincreaseinage,withasignificantincreasefromthe18-24tothe25-34agegroup.• Blacksreportedhavingahigherprevalenceofbeingoverweightandobesecomparedtowhitesin2007.(Figure25)

80

60

40

20

0male female

71.7%

61.8%

white18-24

47.4%

25-34

65.4%

35-44

68.3%

45-54

73.6%

55-64

74.7%

65+

65.5%

• TheprevalenceofoverweightandobesityhadincreasedsignificantlyinAlabamafrom1998to2007.Thetrendfollowedthesame pattern as that of the united States.

• In2007,theprevalenceofreportedoverweightandobesepeoplewas3.6percentagepointshigherinAlabamathanthenational average. (Figure 24)

fiGure 24: Prevalence of overweiGht and obese in alabama and the united states 2007

59.6 60.8 60.7 61.7 62.7 63.2 64.6 64.5 65.0 66.6

54.6 56.6 56.8 58.3 59.2 59.5 60.1 61.1 61.6 63.0


1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

80

60

40

20

0

overweight (defined as a body mass index of 25.0 - 29.9 kg/m2) and obesity (defined as a body mass index > 30.0 kg/m2) are common factors contributing to the risk of heart disease and stroke. overweight and obese individuals are also more likely to have other risk factors for heart disease and stroke, including high blood pressure, high cholesterol, high triglycerides, and diabetes.

cardiovascular risk factors: overweiGht and obesity

year

Pe

rc

en

tP

er

ce

nt



21

LAUDERDALE

LAWRENCE

LIMESTONE

MORGAN

CULLMAN

MARSHALLDEKALB

CHEROKEE

CALHOUN

CLEBURNE

RANDOLPHCLAY

TALLADEGA

COOSATALLAPOOSA

CHAMBERS

ETOWAH

BLOUNT

ST. CLAIR

SHELBY

JEFFERSON

LAMARFAYETTE

TUSCALOOSA

BIBB

GREENE

SUMTER

CHOCTAW

MARENGO

HALE

PERRY

DALLAS

WILCOX

LOWNDES

AUTAUGA

CHILTON

ELMORE

MONTGOMERY

MACON

BULLOCK

PIKE

CRENSHAW

BUTLER

CONECUH

MONROE

CLARKE

WASHINGTON

BALDWIN

COVINGTON

ESCAMBIA

MOBILE

COFFEEDALE

BARBOUR

HENRY

HOUSTONGENEVA

RUSSELL

LEE

PICKENS

JACKSONMADISON

COLBERT

FRANKLIN

MARION WINSTON

WALKER

area

11

area

9 area

10

area

8

area

7

area

3

area

4area

6

area

5

area

2area

1

64%64%

70%

73%74%

67%

63%

71%

63%

64%

69%

fiGure 26: PercentaGe of adults who are overweiGht or obese in alabama by Public health area 2007


22

fiGure 28: Prevalence of current smokers 2007 by Gender, aGe, and race

• Malesweresignificantlymorelikelytobecurrentsmokersthanfemales.• Uptothe55-64agegrouptheprevalencerateofcurrentsmokersshowedlittlevariance,andthenshowedasignificant

decrease in the 65 and older age group.• Theratesweresimilarbetweenwhitesandblackswithlittledifference.(Figure28)

black

21.2%22.8%

40

30

20

10

0male female

27.5%

19.6%

white18-24

29.0%

25-34

23.6%

35-44

26.5%

45-54

25.4%

55-64

23.4%

65+

8.9%

• Theprevalenceofcurrentsmokershasdecreasedovertheperiodof10yearsbothinAlabamaby9percentandintheUnitedStates by 14 percent.

• Alabama’srateofcurrentsmokerswashigherthanthenationalaverageratesfrom1998-2007.• 22.5percentofAlabamaresidentsreportedthattheysmokein2007.(Figure27)

fiGure 27: Prevalence of current smokers in alabama and united states 1999-2007

24.6

23.5

25.2

23.824.4

25.4

24.8 24.8

23.222.5

22.922.6

23.222.8 23.0

22.0

21.220.5

20.0 19.7


1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

26

24

22

20

18

cigarette smoking is a major cause of heart disease and stroke. It increases the clotting factors in the blood, damages the linings of the blood vessels, and decreases HdL (the good cholesterol) in the blood. Smokers have twice the risk of heart attack or stroke than non-smokers. About 190,000 deaths a year in the united States are smoking-related. It is the single largest preventable cause of heart disease in the united States.

cardiovascular risk factors: smokinG

year

Pe

rc

en

tP

er

ce

nt



23

LAUDERDALE

LAWRENCE

LIMESTONE

MORGAN

CULLMAN

MARSHALLDEKALB

CHEROKEE

CALHOUN

CLEBURNE

RANDOLPHCLAY

TALLADEGA

COOSATALLAPOOSA

CHAMBERS

ETOWAH

BLOUNT

ST. CLAIR

SHELBY

JEFFERSON

LAMARFAYETTE

TUSCALOOSA

BIBB

GREENE

SUMTER

CHOCTAW

MARENGO

HALE

PERRY

DALLAS

WILCOX

LOWNDES

AUTAUGA

CHILTON

ELMORE

MONTGOMERY

MACON

BULLOCK

PIKE

CRENSHAW

BUTLER

CONECUH

MONROE

CLARKE

WASHINGTON

BALDWIN

COVINGTON

ESCAMBIA

MOBILE

COFFEEDALE

BARBOUR

HENRY

HOUSTONGENEVA

RUSSELL

LEE

PICKENS

JACKSONMADISON

COLBERT

FRANKLIN

MARION WINSTON

WALKER

area

11

area

9 area

10

area

8

area

7

area

3

area

4area

6

area

5

area

2area

1

26%24%

21%

17%21%

20%

21%

29%

29%

21%

25%

fiGure 29: PercentaGe of adults who are current smokers in alabama by Public health area 2007


24

fiGure 31: Prevalence of Physical inactivity in alabama 2007 by Gender, aGe, and race

• InAlabama,femalesweremorelikelytobephysicallyinactivethanmales.• Theprevalencerateofphysicalinactivityincreaseswithanincreaseinage.• Among raceandethnic groups,blackshadahigherprevalence rate ofphysical inactivitywhencompared towhites.

(Figure 31)

black

32.7%29.1%

40

30

20

10

0male female

25.5%

33.6%

white18-24

23.2%

25-34

19.6%

35-44

30.4%

45-54

31.4%

55-64

34.1%

65+

38.6%

• InAlabama,theprevalenceofphysicalinactivityhasgraduallydeclinedoverthepast10years.• Therewasasignificantdecreaseof16percentinphysicalinactivityamongUnitedStatesadultscomparedtoa7percent

decrease in Alabama adults from 1998 to 2007. (Figure 30)

* Physical inactivity is defined as those reporting no physical activity or exercise in the last thirty days.

fiGure 30: Prevalence of Physical inactivity* in alabama and the united states 2000-2007

the chances of developing heart disease is 1.5 to 2.5 times higher among those who are physically inactive compared to those who are physically active. exercise reduces the development of high blood pressure, controls diabetes, lowers weight, and decreases high blood cholesterol.

cardiovascular risk factors: Physical inactivity


1998 2001 2002 2003 2004 2005 2006 2007

35

30

25

20

15

31.6 31.2

27.3

29.9 29.6 29.7 29.2 29.3

26.725.2 24.6

22.9 22.623.7

22.6 22.5

year

Pe

rc

en

tP

er

ce

nt



25

LAUDERDALE

LAWRENCE

LIMESTONE

MORGAN

CULLMAN

MARSHALLDEKALB

CHEROKEE

CALHOUN

CLEBURNE

RANDOLPHCLAY

TALLADEGA

COOSATALLAPOOSA

CHAMBERS

ETOWAH

BLOUNT

ST. CLAIR

SHELBY

JEFFERSON

LAMARFAYETTE

TUSCALOOSA

BIBB

GREENE

SUMTER

CHOCTAW

MARENGO

HALE

PERRY

DALLAS

WILCOX

LOWNDES

AUTAUGA

CHILTON

ELMORE

MONTGOMERY

MACON

BULLOCK

PIKE

CRENSHAW

BUTLER

CONECUH

MONROE

CLARKE

WASHINGTON

BALDWIN

COVINGTON

ESCAMBIA

MOBILE

COFFEEDALE

BARBOUR

HENRY

HOUSTONGENEVA

RUSSELL

LEE

PICKENS

JACKSONMADISON

COLBERT

FRANKLIN

MARION WINSTON

WALKER

area

11

area

9 area

10

area

8

area

7

area

3

area

4area

6

area

5

area

2area

1

31%33%

29%

23%33%

32%

31%

33%

29%

26%

32%

fiGure 32: PercentaGe of adults who are Physically inactive* in alabama by Public health area 2007

Source: Alabama brFSS* Physical inactivity is defined as those reporting no physical activity or exercise in the last thirty days.

26

fiGure 34: Prevalence of consuminG five or more fruits and veGetables Per day in alabama 2007 by Gender, aGe, and race

• Accordingtothe2007BRFSS,thereisadifferenceofnearly3.8percentagepointsintheconsumptionoffiveormoredailyservings of fruits and vegetables between Alabama residents and the rest of the united States.

• Femalesweremorelikelytoconsumefiveormoreservingsperdayoffruitsandvegetablescomparedtomales.• Amongagegroups,the18-24and25-34agegroupsdidnotconsumeenoughfruitsandvegetableswiththerestoftheage

groups being very similar in 2007.• Amongraceandethnicgroups,therewerenosignificantdifferencesofconsumptionamongwhitesandblacks.(Figure34)

black

18.1%21.1%

40

30

20

10

0male female

16.8%

24.1%

white18-24

17.5%

25-34

18.5%

35-44

22.0%

45-54

19.8%

55-64

23.6%

65+

21.9%

daily consumption of 5 to 10 servings of fresh fruits and vegetables is associated with a reduced risk of heart disease and stroke. the consumption of recommended amounts of fruits and vegetables results in the intake of antioxidants, natural vitamins, and fiber. Inadequate consumption of fruits and vegetables is associated with the development of several cVd risk factors, particularly hypertension, high blood cholesterol, overweight, and diabetes.

cardiovascular risk factors: fruit and veGetable consumPtion

• Theprevalenceofadequateamountsoffruitsandvegetablesconsumptionhasnotchangedsignificantlyforthestateinthe past 13 years.

• Theratehasalmostremainedconstantat20.6percent.(Figure33)

fiGure 33: Prevalence of consuminG five or more fruits and veGetables Per day in alabama and the united states 1995-2007


1996 1998 2000 2002 2003 2005 2007

30

25

20

15

10

21.4

23.9

22.7

21.122.6

20.1 20.6

23.7

23.823.2

22.7 22.623.2

24.3

year

Pe

rc

en

tP

er

ce

nt



27

LAUDERDALE

LAWRENCE

LIMESTONE

MORGAN

CULLMAN

MARSHALLDEKALB

CHEROKEE

CALHOUN

CLEBURNE

RANDOLPHCLAY

TALLADEGA

COOSATALLAPOOSA

CHAMBERS

ETOWAH

BLOUNT

ST. CLAIR

SHELBY

JEFFERSON

LAMARFAYETTE

TUSCALOOSA

BIBB

GREENE

SUMTER

CHOCTAW

MARENGO

HALE

PERRY

DALLAS

WILCOX

LOWNDES

AUTAUGA

CHILTON

ELMORE

MONTGOMERY

MACON

BULLOCK

PIKE

CRENSHAW

BUTLER

CONECUH

MONROE

CLARKE

WASHINGTON

BALDWIN

COVINGTON

ESCAMBIA

MOBILE

COFFEEDALE

BARBOUR

HENRY

HOUSTONGENEVA

RUSSELL

LEE

PICKENS

JACKSONMADISON

COLBERT

FRANKLIN

MARION WINSTON

WALKER

area

11

area

9 area

10

area

8

area

7

area

3

area

4area

6

area

5

area

2area

1

18%21%

23%

25%20%

18%

19%

23%

20%

21%

20%

fiGure 35: PercentaGe of adults consuminG five servinGs of fruit and veGetables in alabama by Public health area 2007


28

one of the Healthy People 2010 objectives is to increase the proportion of people who are aware of the early warning signs and symptoms of stroke. one of the factors known to adversely affect the outcome of an acute heart attack or stroke event is the time between the onset of symptoms and actually receiving treatment. there are three stages at which time delays can occur: 1) the onset of symptoms and the 911 call for help; 2) during pre-hospital care; and 3) during transportation.

Stroke: the FASt test

the fast test is an easy way to recognize and remember the signs of stroke or a transient ischemic attack (tIA). using the fast test involves asking three simple questions.

fast stands for:

• Facialweakness-canthepersonsmile;havetheirmouthoreyesdrooped? • Armweakness-canthepersonraisebotharms?

• Speech/sightdifficulty-canthepersonspeakorseeclearlyandunderstandwhatyousay?

• Timetoact-Timeisbrainlost.Call911.

If you suddenly experience any of these symptoms, get to a hospital immediately. remember, stroke is a life-threatening emergency.

Heart Attack: Signs and Symptoms of a Heart Attack • Painordiscomfortinjaw,neck,orback • Feelingweak,lightheaded,faint • Chestpainordiscomfort • Shortnessofbreath • Painordiscomfortinarmsorshoulders

A risk factor that can cause heart attack and stroke is high blood pressure or hypertension. the national guidelines for defining hypertension is the following.

Seventh report of the Joint national committee on Prevention, detection, evaluation, and treatment of High blood Pressure (Jnc7)

siGns and symPtoms of heart attack or stroke

Another risk factor that can lead to heart attack and stroke is smoking. Imagine yourself tobacco free! call 1-800-QuIt-noW, the AdPH tobacco Quitline.

classification of blood Pressure (bP)

cAtegorySbP mm Hg

SystolicdbP mm Hg

Systolic

normal <120 and <80

Pre-hypertension 120-139 or 80-89

Hypertension, Stage 1 140-159 or 90-99

Hypertension, Stage 2 >160 or >100

29

Alabama department of Public Health ......................donald e. Williamson, m.d., State Health officerPersonal and community Health ..............................thomas m. miller, m.d., m.P.H., Assistant State Health officerbureau of Health Promotion and chronic disease .....Jim mcVay, dr.P.A., bureau directorchronic disease Prevention office ............................Jack Hataway, m.d., m.P.H., directorchronic disease epidemiology branch ......................Sondra reese, m.P.H., directorbrFSS unit .............................................................Jesse Pevear, III, m.S.P.H., coordinatorcardiovascular Health branch ..................................melanie rightmyer, r.n., Program manager

acknowledGements

American Heart Association. Heart disease and Stroke Statistics – 2008 update. retrieved from: http://www.americanheart.org

centers for disease control and Prevention (cdc). behavioral risk Factor Surveillance System (brFSS): overview and a brief History. retrieved from: http://www.cdc.gov/brfss/about.htm centers for disease control and Prevention (cdc). behavioral risk Factor Surveillance System (brFSS). retrieved from: http://www.cdc.gov/brfss centers for disease control and Prevention. cdc Wonder. http://wonder.cdc.gov

united States census bureau. American Fact Finder. (2007). retrieved from: http://www.census.gov

references

this publication was supported by grant/cooperative Agreement number 1 u50 dP-00071320-02 from the cdc. Its contents are solely the responsibility of its authors and do not necessarily represent the official views of the cdc.

Documents

the risk of heart disease and stroke in alabama: burden ...alabamapublichealth.gov/cardio/assets/2009_Heart... · Although heart disease and stroke are largely preventable, these