introduction
DESCRIPTION
Correlation of Socioeconomic Factors with Cardiovascular Disease Burden in Maryland. Introduction. - PowerPoint PPT PresentationTRANSCRIPT
Introduction
Correlation of Socioeconomic Factors with Cardiovascular Disease Burden in Maryland
Xiao-Ying Yu, Maria Prince, Audrey Regan
Maryland Department of Health and Mental Hygiene, Family Health Administration, Office of Chronic Disease Prevention
Conclusion
Summary
Methods Table1. Correlation* between Five Elements of Social Economic Factors** and Age-adjusted YPLL Rate, Hospital Discharge Rate and Prevalence for Cardiovascular Disease
**Social and economic factors consist of five elements. They are: 1. Employment: Percent of the population that is unemployed and seeking work.2. Income: Income inequality and percent of children in poverty.3. Education: High school graduation rate and percent of adults (age > 25 years) with 4-year college degree or higher. Higher ranking indicates lower education rates.4. Family and social support: Percent of adults reporting that they do not receive the social/emotional support they need and percent of households that are single-parent.5. Community safety: Violent crime rate per 100,000 people or homicide death rate per 100,000 people.
Public Health Implications
Results from age-adjusted YPLL rate analyses related to cardiovascular disease suggest that coronary heart disease is the most important cause of death affecting Maryland’s younger age people.
Of the five components of social and economic factors measured, lower employment rates and lower income were more associated with a higher age-adjusted YPLL rate of heart diseases and stroke.
Analysis of crude and age-adjusted death rates is important to quantify the relative importance of various causes of death. In 2009, heart disease and stoke continued to be the 1st and 3rd leading causes of death in Maryland. The public health impact of heart disease and stroke on premature death by Maryland jurisdictions and the linkage of socioeconomic factors and cardiovascular disease burden have not been previously examined.
The study objectives are to assess the causes of death of various types of cardiovascular disease that affect younger age groups in Maryland and to examine by jurisdiction the relationship between socioeconomic factors and cardiovascular diseases burden by using age-adjusted Years of Potential Life Lost (YPLL) rate,1 hospital discharge rate, and prevalence.
Jurisdictions with lower socioeconomic status and employment had:1. Higher age-adjusted YPLL rate for cardiovascular diseases, especially coronary heart disease (Figure 1-4). 2. Higher hospitalization rates for heart failure (Table 1). 3. Higher rates of stroke and heart attack prevalence and associated risk factors such as cholesterol and high blood pressure (Table 1).
Social and economic factors were collected from County Health Rankings (2005-2008) for Maryland’s 24 jurisdictions.2 A higher ranking indicates a lower (worse) socioeconomic condition for that jurisdiction.
Age-adjusted YPLL rates, which provide a more accurate picture of premature mortality, were used to measure the age-adjusted number of years lost by the people who died before 75. It was calculated by sum of age-specific YPLL-75 rates that were weighted according to the 2000 U.S. standard population. Hospital discharge rates from cardiovascular disease were calculated as age-adjusted rates per 100,000 population. Death and hospital discharge data were collected by jurisdiction from the Maryland Assessment Tool for Community Health, MATCH (2005-2009).3 The prevalence of cardiovascular disease and associated risk factors were collected by jurisdiction from Maryland BRFSS (2005-2008).4
Descriptive statistical analyses were conducted. Spearman’s rank correlation coefficient was chosen to evaluate bi-variable associations using SAS. As Spearman’s rho (rs) approaches 1, two variables have a stronger association. Significance is expressed by p<0.05.
•Data are expressed as Spearman’s rank correlation coefficients (rho); as rho approaches 1, two variables have a stronger associationAge-adjusted YPLL rates based on fewer than 5 deaths are not included.
Age-adjusted YPLL rate can be used as an indicator for measuring the public health impact of disease and evaluating the effectiveness of state and local chronic disease interventions. Cardiovascular prevention and control efforts should consider social and economic factors, such as employment, income, education, family and social support, and community safety. References1.Premature mortality in the United States: Public Health Issues in the Use of Years of Potential Life Lost CDC MMWR 1986 35(2s);1s-11s
2. Maryland County Health Rankings http://www.countyhealthrank.org
3. Maryland Assessment Tool for Community Health http://www.dhmhmatch.org
4. Maryland BRFSS: http://www.marylandbrfss.org
Poster ID# 1062666
Results
Figure 3. Relationship between Employment Factors and Age-adjusted YPLL Rate per 100,000 Population from Cardiovascular Disease in Maryland, 2005-2009
0
200
400
600
800
1000
0 4 8 12 16 20 24
Employment Factors
Ag
e-a
dju
ste
d Y
PL
L R
ate
/100,0
00 P
op
ula
tio
ns
CHD rho=0.78, p<0.0001
Heart attack, rho=0.61, p<0.001
Hypertensive heart disease, rho=0.67, p<0.0003
Stroke, rho=0.73, p<0.0001
Figure 4. Relationship between Income Factors and Age-adjusted YPLL Rate per 100,000 Population from Cardiovascular Disease in Maryland, 2005-2009
0
200
400
600
800
1000
0 4 8 12 16 20 24
Income Factors
CHD rho=0.78, p<0.0001
Heart attack, rho=0.52, p<0.009
Hypertensive heart disease, rho=0.69, p<0.0002
Stroke, rho=0.76, p<0.0001
Figure 5. Age-adjusted YPLL Rate per 100,000 population from Cardiovascular Disease in Maryland by Jurisdiction from 2005-2009
0 200 400 600 800 1,000 1,200 1,400 1,600 1,800 2,000
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Ju
risd
icti
on
Age-adjusted YPLL rate per 100,000 population
Coronary Heart Disease
Heart Attack
Hypertensive HD
Stroke
Figure 1. Age-adjusted Potential Life Lost (YPLL) Rates per 100,000 Population from Cardiovascular Disease in Maryland (2005-2009)
397.9
198.1
157.8
23.4
166.5
0
100
200
300
400
500
Coronary HeartDisease
Heart Attack HypertensiveHeart Disease
Heart Failure Stroke
Ag
e-a
dju
ste
d Y
PL
L r
ate
/100,0
00 p
op
ula
tio
n
Figure 2. Relationship between Social and Economic Factors and Age-adjusted YPLL Rate per 100,000 Population from Cardiovascular Disease in Maryland, 2005-2009
0
200
400
600
800
1,000
0 4 8 12 16 20 24
Social and Economic Factors
Ag
e-a
dju
ste
d Y
PL
L R
ate
/10
0,0
00
Po
pu
lati
on
s
CHD rho=0.83, p<0.0001
Heart attack, rho=0.59, p<0.002
Hypertensive heart disease, rho=0.73, p<0.0001
Stroke, rho=0.83, p<0.0001