OREGON STATE OF THE HEART AND STROKE REPORT 2001 PREPARED BY THE OREGON DEPARTMENT OF HUMAN SERVICES HEALTH SERVICES HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION PROGRAM www.healthoregon.org/hpcdp
Contents Introduction---- (Figure 1, Leading Causes of Death in Oregon, 2001).. 2 Heart Disease Stroke Trends in Cardiovascular Disease Mortality in Oregon.. 3 Fig. 2, Cardiovascular disease death rates in Oregon and United States, 1990-2000. 3 Fig. 3, Cardiovascular disease death rates in Oregon, by race, 1996-2001 3 Table 1, Premature cardiovascular disease deaths in Oregon, by sex, 2001 4 Heart Disease 4 Fig. 4, Heart disease death rates in Oregon and United States, 1990-2000 4 Fig. 5, Heart disease deaths in Oregon by race and ethnicity, 1996-2001.. 4 Table 2, Premature heart disease deaths in Oregon, by sex, 2001.. 5 Stroke.. 5 Fig. 6, Stroke death rates in Oregon and United States, 1990-2000 5 Fig. 7, Stroke deaths in Oregon, by race and ethnicity, 1996-2001. 5 Table 3, Premature stroke deaths in Oregon by sex, 2001... 6 Prevalence of Cardiovascular Disease Heart Disease and Stroke 6 Hospitalizations for Cardiovascular Disease Heart Disease and Stroke. 6 Cardiovascular Disease Heart Disease and Stroke Risk Factors 6 Smoking: Fig. 8, Percent of adult Oregonians reporting current smoking, 1993-2001 7 HBP: Fig. 9, Percent of adult Oregonians reporting high blood pressure, by age, 2001.. 7 HBC: Fig. 10, Percent of adult Oregonians reporting high cholesterol, by sex and year.. 8 Physical Activity and Being Overweight. 8 Fig. 11, Percent of overweight and obesity among adult Oregonians, 1994-2001. 8 Race/Ethnicity Prevalence and Risk Factors, 2000 2001.. 9 Smoking: Fig. 12, Percent of adult Oregonians who smoke, by race/ethnicity. 9 HBP: Fig. 13, Percent of adult Oregonians reporting high blood pressure, by race/ethnicity... 9 HBC: Fig. 14, Percent of adult Oregonians reporting high cholesterol, by race/ethnicity 10 Physical Activity and Being Overweight. 10 Fig. 15, Percent of overweight and obesity, by race/ethnicity. 10 Conclusions.. 11
Introduction Cardiovascular disease (CVD) is the leading cause of death in Oregon, accounting for 35 percent of all deaths in 2001 (Figure 1). The most common causes of CVD mortality are heart attack and stroke. CVD is also a major cause of costly hospitalization and disability. During 2001, there were 50,423 CVD-related hospitalizations in Oregon, resulting in hospital charges of $782 million. Fig 1. Leading Causes of Death in Oregon, 2001 All deaths = 30,128 Cardiovascular disease (CVD) = 10,623 Chronic Lung Disease 5.8% Pneumonia, Influenza 1.9% AIDS 0.2% Injuries 4.2% Diabetes 3.4% Other 25.7% Cancer 23.5% CVD 35.3% Disease of Heart 66.6% Stroke 24.4% Other CVD 9.1% Source: 2001 Oregon Death Certificates Death rates from heart disease have been declining in the past decade; however, death rates for stroke have increased steadily. This trend may reflect changes in the prevalence of risk factors contributing to CVD. Age-adjusted death rates from CVD in Oregon are about 42 percent higher for males (350.5) than females (245.9). In addition, the percentage of premature CVD deaths in Oregon, those occurring in persons younger than 65 years of age, is higher among males (18%) than females (8%). Death and disability from CVD are related to a number of modifiable risk factors, including high blood cholesterol, high blood pressure, smoking, lack of regular physical activity, diabetes, and being overweight or obese. Oregonians could reduce much of the burden of death and disability from CVD by adopting healthier lifestyles. This report describes the burden of CVD, heart disease, and stroke in Oregon. Its purpose is to present a brief overview of CVD, heart disease, and stroke death rates in the past decade; to report the cost of CVD, heart disease, and stroke in terms of hospitalizations; and to describe the prevalence of CVD, heart disease, stroke and the risk factors for them among Oregonians. In addition, the report reviews the prevalence and risk factors for CVD, heart disease, and stroke by race and ethnicity. All age-adjusted rates in this report are based on the U.S. Census 2000 standard population). Rates per 100,000 population. 2
Trends in Cardiovascular Disease Cardiovascular disease (CVD) death rates have declined in both Oregon and the U.S. over the past decade. The decline in CVD death rates is presumably due to improvements in medical care and possibly to healthier lifestyles. Oregon s rates have remained approximately 12 percent below the national rate during this period (Figure 2). Age-adjusted death rate per 100,000 population Fig 2. Cardiovascular Disease Death Rates in Oregon and the United States, 1990-2000 500 400 300 200 100 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Source: CDC Wonder Oregon Year U.S. CVD age-adjusted death rates for men (350.5) are higher than those for women (245.9). However, in terms of absolute numbers, there are actually more deaths among females (5,592) than males (5,031). Fig 3. Cardiovascular Disease (CVD) Deaths in Oregon, by Race, 1996-2001 500 In Oregon, the racial disparity in the risk for dying from CVD is striking. African s have higher death rates than any other racial/ethnic group (Figure 3). Age-adjusted death rate per 100,000 400 300 200 100 0 White, Not Hispanic or Latino African Asian/PI Hispanic or Latino Source: 1996-2001 Oregon Death Certificates 3
The percentage of deaths occurring before 65 years of age is one measure of premature death. One in eight Oregonians who died from CVD in 2001 was younger than 65 years of age. Table 1. Premature Cardiovascular Disease (CVD) Deaths in Oregon by Sex, 2001 Percent of CVD deaths before age 65 years Males 18% Females 8% Source: 2001 Oregon Death Certificates Trends in Heart Disease Most CVD deaths are due to ischemic heart disease, one of the most prevalent and preventable forms of CVD. Even though the heart disease death rate has declined during the past decade, heart disease continues to be a leading cause of death in Oregon, accounting for one of every four deaths. Oregon s rates have remained approximately 3 below the national rate during this period (Figure 4). Death rate per 100,000 400 300 200 100 0 Fig 4. Heart Disease Death Rates in Oregon and the United States, 1990-2000 1990 1991 1992 Source: CDC Wonder 1993 1994 1995 US Heart Disease Rates Year 1996 1997 1998 1999 2000 Oregon Heart Disease Rates Disparities across racial and ethnic groups are shown in Figure 5. In Oregon, African s have the highest age-adjusted death rates of all racial/ethnic groups. Age-adjusted death rate per 100,000 300 200 100 0 Fig 5. Heart Disease Deaths in Oregon, by Race and Ethnicity, 1996-2001 White, Not Hispanic or Latino African Asian/PI Hispanic or Latino Source: 1996-2001 Oregon Death Certificates 4
In 2001, men had a higher percentage of premature heart disease deaths (deaths occurring before age 65 years) than did women. One in seven Oregonians who died from heart disease was younger than 65 years of age. Table 2. Premature Heart Disease Deaths in Oregon, by Sex, 2001 Percent of heart disease deaths before age 65 years Males 21% Females 9% Source: 2001 Oregon Death Certificates Trends in Stroke Fig. 6 Stroke Death Rates in Oregon and the United States, 1990-2000 Stroke is a leading cause of severe disability and is the third leading cause of death in the U.S. Oregon ranked 3rd in the nation for stroke mortality in 2000. Oregon s stroke death rate steadily increased between 1990 and 1999, before decreasing slightly in 2000 (Figure 6). Aged-adjusted death rate per 100,000 90 80 70 60 50 40 30 20 10 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 US Stroke Rates Oregon Stroke Rates Source: CDC Wonder Fig. 7 Stroke Deaths in Oregon, by Race and Ethnicity, 1996-2001 120 In Oregon, African s have the highest stroke death rate of all racial and ethnic groups (Figure 7). Age-adjusted death rate per 100,000 100 80 60 40 20 0 White, Not Hispanic or Latino African Asian/PI Hispanic or Latino Source: 1996-2001 Oregon Death Certificates 5
Table 3. Premature Stroke Deaths in Oregon, by Sex, 2001 In 2001, men had a higher percentage of premature stroke deaths (deaths occurring before age 65) than did women (Table 3). Percent of stroke deaths before age 65 years Males 11% Females 6% Source: 2001 Oregon Death Certificates Prevalence of Cardiovascular Disease Heart Disease and Stroke Among Oregonians 45 years or older who were interviewed in the 2001 BRFSS, 7% reported having been told by a health care provider that they had a heart attack or myocardial infarction, 9% reported having been told they had angina or coronary heart disease, and 4% reported having been told they had a stroke. Hospitalizations for Cardiovascular Disease Heart Disease and Stroke In addition to the 10,623 deaths caused by CVD each year, many more Oregonians experienced a heart attack, stroke, or other CVD event, but did not die from the condition. For most of these CVD survivors, their lives are forever changed. Most will need to take medications for the rest of their lives, and some are left with permanent, severe disabilities such as the loss of speech or the inability to move an arm or leg. We can estimate some of the burden from non-fatal CVD in Oregon by examining hospitalizations. In 2001, there were 50,423 hospitalizations for CVD among Oregon residents. Of these, 34,306 hospitalizations were for heart disease and 8,676 were for stroke. These hospitalizations consumed enormous health and financial resources. Oregonians spent a total of $782 million in hospitalization costs for CVD, $549 million for heart disease and $103 million for stroke. The average charge for a CVD-associated hospital stay was $15,500. Heart disease hospitalization costs averaged $15,888, while the average for stroke hospitalizations was $11,851. Costs due to CVD-associated long-term care, rehabilitation, lost productivity and lost family resources are not included in the above totals and would drive the CVD-associated economic burden much higher. Further, the costs due to CVD-related hospitalizations are underestimated, since Kaiser Permanente and Veteran s Administration hospitals do not participate in the hospital discharge database. Cardiovascular Disease Heart Disease and Stroke Risk Factors Some CVD risk factors are modifiable, meaning that individuals who control these factors can slow, or even reverse, the process of arterial blockage and decrease their risk of having a heart attack or stroke. Modifiable risk factors include smoking, high blood pressure, high blood cholesterol levels, being overweight, and lack of regular physical activity. 6
A few CVD risk factors cannot be changed, such as age, male gender, and family history of heart attack or stroke. Individuals with non-modifiable risk factors should be particularly diligent in avoiding or controlling the modifiable risk factors. Smoking The prevalence of smoking among adult Oregonians has declined from 23% in 1993 to 21% in 2001 (Figure 8). In 2002 preliminary data, of Oregon adults reported they smoked cigarettes. Lowering smoking rates is a public health priority. In addition to its well-known association with cancer, smoking is a major CVD risk factor. Each year, smoking causes more deaths from heart attacks than from cancer. The good news is that giving up smoking rapidly reduces the chance of developing CVD. Percent of Adult Oregonians 3 25% 15% 1 5% Fig. 8 - Percent of Adult Oregonians Reporting Current Smoking, 1993-2001 1993 1994 1995 1996 1997 1998 1999 2000 2001 Source: 1993 2001 BRFSS Year High Blood Pressure High blood pressure is a major risk factor for both heart attack and stroke. The percentage of adult Oregonians who reported being told by a health care provider that they had high blood pressure has remained in the 23% to 25% range since 1997. In Oregon, prevalence of reported high blood pressure increases with age (Figure 9). Many people with high blood pressure can control it by losing weight and engaging in regular physical activity. Percent of Adult Oregonians 6 5 4 3 1 Fig. 9 Percentage of Adult Oregonians who Reported High Blood Pressure, by Age, 2001 Source: 2001 BRFSS 18-24 25-34 35-44 45-54 55-64 65+ Age 7
High Blood Cholesterol Level High blood cholesterol is another risk factor for CVD. The percentage of adult Oregonians who reported being told by a health care provider that they had high blood cholesterol has remained in the 33% to 37% range since 1997. More men reported having been told they had high blood cholesterol than did women (Figure 10). For those who are unable to decrease their blood cholesterol level by lifestyle modification alone, medications prescribed by a health care provider can treat high cholesterol successfully. Percent of Adult Oregonians 4 3 1 Source: 1999 and 2001 BRFSS Fig. 10 Percentage of Adult Oregonians Who Reported a High Blood Cholesterol Level, by Sex and Year 1999 2001 Year Male Female Physical Activity and Being Overweight Many Oregonians are overweight and are not physically active on a regular basis. Two out of every five Oregon adults get regular physical activity (at least 30 minutes of moderate or vigorous activity each day on five or more days a week). There has been a steady increase in the percentage of overweight (BMI of 25 to 29.9) adults. In 2001, 6 of adult Oregonians were overweight or obese (BMI of 30 or greater). Since 1994, overweight or obesity among Oregonians has increased by 24% (Figure 11). Percent of Adult Oregonians 8 6 4 Source: 1994 2001 BRFSS Fig. 11 Percentage of Overweight and Obesity Among Adult Oregonians, 1994-2001 1994 1995 1996 1997 1998 1999 2000 2001 Year Losing weight and being physically active on a regular basis can improve blood pressure and cholesterol levels and can decrease the chances of developing diabetes, another risk factor for heart disease. 8
Race and Ethnicity Prevalence and Risk Factors The burden of CVD, heart disease, and stroke is greater for certain racial and ethnic populations, Prevalence for heart disease and stroke suggest that racial disparities exist among Oregonians. Among Indians and Alaska s, 6% reported a history of heart attack, compared with 1% among African s, Asian/Pacific Islanders, and Hispanics. Self-reported coronary heart disease prevalence and stroke prevalence in 2001 were 2% and 3% for African s, 4% and 2% for Indians/Alaska s, 4% and 1% for Asian/Pacific Islanders, and 1% and 1% for Hispanics. (CVD prevalence questions were new in 2000, and the preceding rates should be interpreted with caution.) There is also evidence that risk factors for CVD disproportionately affect different racial/ethnic groups. Smoking Fig. 12 Percentage of Adult Oregonians who Smoke, by Race/Ethnicity, 2000-2001 Indians and Alaska s reported the highest prevalence of smoking in Oregon (Figure 12). It is estimated that two out of every five Indian and Alaska adults smoke. Percent of Adult Oregonians 5 4 3 1 Oregonians African Asian/Pacific Islander Hispanic Source: 2000-2001 BRFSS Race/Ethnicity Augment High Blood Pressure Prevalence of high blood pressure also varied among racial and ethnic groups (Figure 13). African s reported a slightly higher prevalence of high blood pressure than Oregonians in general. Percent of Adult Oregonian 3 25% 15% 1 5% Fig. 13 Percentage of Adult Oregonians who Reported High Blood Pressure, by Race/Ethnicity, 2000-2001 Oregonians African Asian/Pacific Islander Source: 2000-2001 BRFSS Race/Ethnicity Augment Hispanic 9
High Blood Cholesterol Level Reported prevalence of high blood cholesterol was lowest among African s (18%), while higher rates among non-hispanic whites drove the rate among Oregonians overall to 32% (Figure 14). Percent of Adult Oregonian 35% 3 25% 15% 1 5% Fig. 14 Percentage of Adult Oregonians who Reported High Blood Cholesterol, by Race/Ethnicity, 2000-2001 Oregonians African Asian/Pacific Islander Source: 2000-2001 BRFSS Race/Ethnicity Augment Hispanic Physical Activity and Being Overweight Regular physical activity (engaging in at least 30 minutes of moderate or vigorous activity each day on five or more days a week) is reported more frequently among Indians and Alaska s than among other groups. However, Indians and Alaska s also have a relatively high prevalence of overweight and obesity (Figure 15). Percent of Adult Oregonians 10 8 6 4 Fig. 15 Prevalence of Overweight and Obesity, by Race/Ethnicity, 2000-2001 Oregonians Africian Overweight Asian/Pacific Islander Obese Hispanic Source: 2000-2001 BRFSS Race/Ethnicity Augment 10
Conclusions This report summarizes the most recent information available on cardiovascular disease, heart disease, and stroke deaths, and hospitalizations in Oregon. The most important finding of this report is the slow decline in heart disease death rates and the steady increase in stroke death rates over the past decade. It is not possible to explain conclusively the reasons for these changes in CVD death rates. A greater effort should be made to reduce the prevalence of CVD risk factors among all Oregonians. Large disparities exist between racial and ethnic groups regarding frequency of cardiovascular disease risk factors. Measures that can reduce CVD risk include not smoking, eating a healthy diet, engaging in regular physical activity, controlling high blood pressure if present, reducing blood cholesterol if it is elevated, and managing diabetes among those with this condition. 11