Heart Disease and Stroke in New Mexico Facts and Figures: At-A-Glance December
H e a r t D i s e a s e a n d S t r o k e Heart disease and stroke are the two most common conditions that fall under the broad umbrella term of Cardiovascular Disease (CVD), which are diseases that affect the blood supply to the heart, brain and other parts of the body. Heart disease includes conditions that affect the heart, such as coronary heart disease (CHD), congestive heart failure and heart attacks. Stroke, also known as cerebrovascular disease, affects the blood vessels in the brain. A number of factors increase the risk of developing cardiovascular disease. Some factors we cannot control, such as genetics, age and sex. Other factors, however, can be changed to prevent or delay the onset of cardiovascular disease. These are known as modifiable risk factors and include abnormal cholesterol, high blood pressure, prediabetes, diabetes, tobacco use, secondhand smoke (SHS) exposure, physical inactivity, poor nutrition and excess weight. Cardiovascular disease generally takes many years or decades to develop. Therefore, prevention of CVD begins during childhood, where healthy habits can be developed. Prevention continues into adulthood, where maintenance of healthy habits is crucial. Medications and lifestyle changes can help control risk factors such as high cholesterol, high blood pressure, prediabetes and diabetes. It is imperative that resources and opportunities are available for individuals of all ages to engage in healthy lifestyles where they can be active, eat healthy foods, breathe smoke-free air and prevent the onset of risk factors as well as disease. Cardiovascular Disease Risk Factors Percentage of New Mexico Adults with CVD Risk Factors, 27 High Blood Pressure High Cholesterol 25.6% 34.5% In the general population, certain risk factors (e.g., obesity and diabetes) have been increasing over time. Diabetes Current Smoking Secondhand Smoke Exposure (in home)* Insufficient Physical Activity Insufficient Fruit and Vegetable Consumption 7.8% 2.8% 15.5% 46.7% 77.6% Other risk factors (e.g., physical inactivity) have remained relatively static or have decreased (e.g., SHS exposure in public places). Reducing and controlling risk factors is crucial in preventing the onset of CVD as well as death from CVD. Obesity 25.1% Data Source: Behavioral Risk Factor Surveillance System, 27. * Data Source: New Mexico Adult Tobacco Survey, 26. % 25% 5% 75% 1%
Cardiovascular Disease Burden Percentage of New Mexico Adults with a History of CVD, 27 Any of the below * Stroke 2.6% 7.3% In 27, over 7% of New Mexico adults reported having ever been told by a health professional they had had a heart attack, stroke, coronary heart disease (CHD) or angina (chest pain). Angina or CHD 3.5% This translates to over 19, New Mexico adults living with CVD statewide. Heart Attack 4.%.% 2.5% 5.% 7.5% 1.% The percentage of adults in New Mexico who report stroke, angina or CHD, or heart attack is similar to adults nationally. Percent (%) Data Source: Behavioral Risk Factor Surveillance System, 27. * Includes anyone who reports having had a stroke, angina or CHD, or a heart attack. Since an individual can report more than one of these conditions, the percentages for each condition do not total the percentage for Any of the below. Cardiovascular Disease Deaths 3 CVD Death Rates, New Mexico, 1991-26 Heart disease is the leading cause of death in New Mexico. Death Rate* 2 1 Stroke is the fifth leading cause of death. In 26, diseases of the heart and stroke combined claimed nearly 4, lives, accounting for over a quarter of all deaths in New Mexico. 1991 1993 1995 Diseases of the Heart Stroke 1997 1999 Year 21 23 25 The rates of death from diseases of the heart and stroke have been declining, primarily from control of certain risk factors (i.e., tobacco, cholesterol and blood pressure), as well as from advances in medicine, so that more people can survive with CVD. Despite the decreasing death rate over the past 15 years, it is important to note that with the increase in some risk factors (i.e., obesity and diabetes), this trend could potentially be reversed in the future if preventive action is not taken. Source: New Mexico Selected Health Statistics Annual Report for 26. *Death rates are the number of deaths per 1, persons, age-adjusted to the 2 U.S. standard population. Population Source: Bureau of Business and Economic Research (BBER), Population Estimates, University of New Mexico. Released. http://www.unm.edu/~bber/.
Heart Disease Deaths by County, numbers* and rates**, 26 39 12 143 62 44 1 1 6 146 175 57 33 171 44 9 91 4 118 3 51 6 46 131 38 78 131 148 125 245 19 Number of deaths (displayed in each county) can be used for county and state resource planning. Rates (represented by shading) should be used for comparing disease impact at county, state and national levels. Heart disease death rates are generally the highest in the southeastern border region of New Mexico. Generally, counties with high rates of heart disease deaths also have higher rates of tobacco use, physical inactivity and obesity. NM total: 3,33 deaths NM rate: 167.8 deaths per 1, people US rate (25): 172.3 deaths per 1, people 8 Legend - Death Rate Missing or Excluded 37.8-137.7 137.71-158.9 158.91-2.7 2.71 + Stroke Deaths by County, numbers* and rates**, 26 37 14 7 1 17 38 216 7 3 7 46 9 5 1 11 4 11 51 Similar to above, use numbers of deaths for resource planning and rates for comparisons between geographic areas. There is not a clear geographical pattern for stroke deaths. Generally, counties with high rates of stroke deaths also have higher rates of hypertension and high cholesterol. 21 1 9 52 14 18 19 NM total: 632 deaths NM rate: 32.2 deaths per 1, people US rate (25): 45.6 deaths per 1, people 8 Legend - Death Rate Missing or Excluded.-19.9 19.91-29.3 29.31-37.7 37.71+ * Number displayed represents the total number of deaths in that county for 26. **Death rates are the number of deaths per 1, persons, age-adjusted to the 2 U.S. standard population, represented here by the shading within each county. Source: New Mexico Selected Health Statistics Annual Report for 26. Rates based on fewer than 2 events may be statistically unreliable and should be interpreted with caution. Deaths occurring in an unknown county, if any, are included in the New Mexico category. Population Source: Bureau of Business and Economic Research (BBER) Population Estimates, University of New Mexico. Released. http://www.unm.edu/~bber/.
Disparities and Social Determinants of Health Although the death rates from diseases of the heart and stroke in New Mexico are lower than the national average, certain subpopulations are disproportionately affected. In 26 in New Mexico, White males had the highest rate of death from heart disease, followed by Black females and then Hispanic males. For stroke, Black males had the highest rate of death, followed by Hispanic females and then Hispanic males. In New Mexico from 1996-2, American Indian/Alaskan Native men, Asian/ Pacific Islander men and Hispanic men and women had higher rates of death from diseases of the heart than their US counterparts. American Indian/Alaskan Native men and Hispanic men and women in New Mexico have historically had higher rates of stroke death than their national counterparts. Social determinants of health are the economic and social conditions under which people live that affect their health. Many of these conditions are risk factors that lie beyond the scope of the behavioral and biological risk factors that directly impact CVD. The social determinants of health that impact CVD include: Social support Income and social status Education and literacy Discrimination Occupation Physical environment (e.g., sanitation, exposure to hazards) Access to resources linked to health (e.g., health care, nutritious foods, places to be physically active) A significantly higher percentage of those earning less than $1, annually report CVD than those earning $5, or more a year. Similarly, those earning less are more likely to experience high blood pressure, diabetes, tobacco use, exposure to secondhand smoke and physical inactivity. Similar to income, a significantly higher percentage of those with less than a high school diploma report a higher level of certain risk factors (i.e., diabetes, tobacco use, poor nutrition, physical inactivity and obesity), than those with a college degree or higher. Effective prevention of CVD, and disparities in general, includes addressing social determinants of health through resource development, improved access to health care services, policy implementation and environmental initiatives. Cost of Cardiovascular Disease In 27, an estimated $39 million was spent in New Mexico on treatment related to heart disease; lost productivity accounted for a loss of an additional $78 million. For stroke, an estimated $7 million was spent on treatment while lost productivity accounted for $13 million (Milken Institute). Of the treatment expenditures for heart disease and stroke in New Mexico in 27, nearly $85 million was estimated to have been paid by Medicaid (Centers for Disease Control and Prevention, ).
Future Needs In order to effectively address heart disease and stroke, a multi-faceted approach needs to be taken to prevent the onset and the progression of disease, including: Reducing and Controlling Risk Factors Create environments with easy access to physical activity opportunities and healthy foods. Continue to reduce the percentage of youth and adults who use tobacco and are exposed to secondhand smoke. Increase the percentage of youth and adults who achieve and maintain a healthy weight. Reduce the percentage of adults and youth who develop abnormal cholesterol, high blood pressure, prediabetes and diabetes. Increase the percentage of adults with well-controlled blood pressure, cholesterol levels and prediabetes or diabetes through medical management and healthy lifestyles. Increase the percentage of clinicians who discuss aspirin therapy with patients at high risk for CHD. Improving Quality of Emergency Response and Treatment to Minimize Death and Disability Increase the percentage of individuals who recognize the signs and symptoms of stroke and heart attacks and dial 9-1-1 promptly. Implement optimal protocols for emergency cardiac and stroke response in emergency management systems and hospital emergency departments. Support integration with other chronic disease efforts, particularly those with common risk factors, such as diabetes, obesity, tobacco use, certain cancers and arthritis. References: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 27. Centers for Disease Control and Prevention (CDC). Chronic Disease Cost Calculator. November. Retrieved November from http://www.cdc.gov/nccdphp/resources/calculator.htm Milken Institute. An Unhealthy America: The Economic Burden of Chronic Disease. October 27. Retrieved November from http://www.chronicdiseaseimpact.com/ Padilla JL. Adults and Tobacco in New Mexico: Report. Chronic Disease Prevention and Control Bureau, New Mexico Department of Health, Albuquerque, NM, October. New Mexico Selected Health Statistics Annual Report for 26. Santa Fe, New Mexico: New Mexico Department of Health, Bureau of Vital Records and Health Statistics.. U.S. Preventive Services Task Force. Aspirin for the Primary Prevention of Cardiovascular Events: Recommendations and Rationale. January 22. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved November from http://www.ahrq.gov/clinic/3rduspstf/aspirin/ asprr.htm Report Author: Nicole VanKim, MPH, CDC/CSTE Applied Epidemiology Fellow Design/layout: Paul Akmajian For more information, please contact: New Mexico Department of Health Chronic Disease Prevention and Control Bureau 531 Central Avenue NE, Suite 8 Albuquerque, New Mexico 8718 (55) 841-584 www.health.state.nm.us This report was supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement U6/CCU7277.