South­ern Liv­ing and Heart Dis­ease

Wellness Update - - Content -

Heart dis­ease kills more South­ern­ers than any other dis­ease, ac­cord­ing to a Cen­ters for Dis­ease Con­trol and Preven­tion re­port.

The rea­sons are com­plex and not com­pletely un­der­stood, but ex­perts be­lieve it is most likely a mix of risk fac­tors, race, poverty and health­care ac­cess in the South.

Ge­orge Howard, a pub­lic health doc­tor and pro­fes­sor of bio­statis­tics at the Univer­sity of Alabama at Birm­ing­ham, said he’d bet that the rea­sons cen­ter on a higher pop­u­la­tion of blacks; more high blood pres­sure and di­a­betes, es­pe­cially in ru­ral ar­eas; and a larger pop­u­la­tion of peo­ple with lower so­cio-eco­nomic sta­tus.

Race plays a role be­cause there are “strik­ing” health dis­par­i­ties be­tween blacks and whites, in­clud­ing a higher like­li­hood of high blood pres­sure, heart at­tacks and strokes among blacks, Howard said.

The sta­tis­tics line up against the re­gion in many ways:

— More than half of all blacks in the U.S., in­clud­ing those of mixed race, live in the South, ac­cord­ing to the 2010 U.S. Cen­sus. Only 10 per­cent of all blacks live in the West.

Even if they get to the doc­tor, they may not have the to­tal pack­age of physicians that can take care of the prob­lems they have. There’s not enough of us to go around,” said car­di­ol­o­gist Myrna Alexan­der-Nick­ens, M.D. as­so­ciate pro­fes­sor of medicine at the Univer­sity of Mis­sis­sippi Med­i­cal Cen­ter in Jack­son. I cer­tainly hope that can­cer passes heart dis­ease in every one of th­ese states,” said Luep­ker, also an AHA vol­un­teer. “I’d like to be No. 10 in deaths, be­cause that is our mis­sion.”

— Half of black men and 46 per­cent of black women had high blood pres­sure, com­pared to a third of white men and less than a third of white women, ac­cord­ing to fed­eral data. Black men and women had nearly twice the rate of di­a­betes as whites: 15.4 per­cent vs. 8.6 per­cent.

— Lower so­cio-eco­nomic sta­tus also has pro­found im­pli­ca­tions for high blood pres­sure, di­a­betes and other heart dis­ease risk fac­tors. Peo­ple who are so­cially dis­ad­van­taged have been found to have higher risks for each.

— In the South, there are fewer med­i­cal pro­fes­sion­als and less ac­cess to health­care, ac­cord­ing to Howard.

In ad­di­tion, Alexan­der-Nick­ens said she’s seen her pa­tients in the South get heav­ier, with more cases of di­a­betes and high blood pres­sure be­gin­ning at younger ages. Chil­dren with risk fac­tors lead to un­health­ier adults, she said.

Cul­tur­ally, South­ern­ers are slow about chang­ing their lifestyles, she added. “We in the South tend to rebel against some of the changes, from our leg­is­la­tors on down.”

Based on the ac­tual num­ber of deaths in 2014, a re­cent CDC re­port showed can­cer had edged out heart dis­ease as the lead­ing cause of death in 22 mostly non-south­ern states.

“I’m not at all sur­prised that can­cer is ris­ing into first place,” Howard said. “I think it re­flects the suc­cess of re­search, the suc­cess of pub­lic health aware­ness, [and] the suc­cess of pop­u­la­tion ef­forts to con­trol heart dis­ease and stroke.”

Christina Clarke-Dur, Ph.D., re­search sci­en­tist at the Can­cer Preven­tion In­sti­tute of Cal­i­for­nia said, “Wow, those peo­ple work­ing on heart dis­ease are do­ing some­thing right.”

The num­bers used by the CDC didn’t ac­count for age, the num­ber of peo­ple liv­ing with a dis­ease, or the death rate, which bet­ter re­flect the risk of death.

Af­ter ad­just­ing the data for age, Clarke-Dur said ad­vances in treat­ing can­cer and heart dis­ease should re­duce the num­ber of deaths from both dis­eases.

“Look­ing at only death un­der­states some of the prob­lems, as there are treat­able heart dis­eases and death can be de­layed,” said epi­demi­ol­o­gist Rus­sell Luep­ker, M.D. pro­fes­sor of epi­demi­ol­ogy and com­mu­nity health at the Univer­sity of Min­nesota in Minneapolis.

Ac­cord­ing to Robert An­der­son, Ph.D., chief of the CDC’s mor­tal­ity sta­tis­tics branch, can­cer and heart dis­ease deaths are run­ning neck-in-neck, even in south­ern states.

For ex­am­ple, South Carolina only had 34 more heart dis­ease deaths than can­cer deaths; Texas had 2,500 more. Alabama, Arkansas, Florida, Ge­or­gia, Louisiana, Mis­sis­sippi and Ten­nessee fell some­where in-be­tween. The gap

About 25 years into the obe­sity epi­demic, there ap­pears to have been a sud­den slow­ing in the progress of de­clin­ing CVD mor­tal­ity rates, with now al­most stag­nant changes in age-ad­justed CVD mor­tal­ity and ac­tual in­creases in crude mor­tal­ity rates and to­tal CVD deaths over the last few years as a re­sult of pop­u­la­tion growth,” he wrote.

be­tween heart dis­ease and can­cer deaths was gen­er­ally lower in west­ern states than in east­ern states, An­der­son said.

De­spite re­duc­tions in heart dis­ease deaths over­all, a Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion study showed that in 2000-2011, the heart dis­ease death rate dropped nearly 4 per­cent, but by 2011-2014, rates dropped by less than one per­cent­age point.

In an editorial to the study, Don­ald Lloyd-Jones, M.D., chair of pre­ven­tive medicine at North­west­ern Univer­sity Feinberg School of Medicine in Chicago sug­gested that higher obe­sity rates may be putting the brakes on progress.

South­ern states topped the charts of the num­ber of peo­ple liv­ing with obe­sity at more than 31 per­cent, ac­cord­ing to the CDC. Alabama, Louisiana, Mis­sis­sippi and West Vir­ginia each had 35 per­cent.

Al­though obe­sity is not a direct risk fac­tor for heart dis­ease or stroke, “it’s a risk fac­tor for the risk fac­tor,” said Howard. “It’s sort of like a time bomb that could bite us down the road.”

An­other risk fac­tor af­fect­ing south­ern states is smok­ing and tobacco use. Alabama, Ken­tucky, Mis­sis­sippi, South Carolina and Texas got straight Fs from the Amer­i­can Lung As­so­ci­a­tion in their ef­forts to re­duce smok­ing. Ge­or­gia, Louisiana and Ten­nessee also achieved low marks.

A com­bi­na­tion of 60 health risks and so­cioe­co­nomic fac­tors led three south­ern states – Arkansas, Mis­sis­sippi and Louisiana – to rank last in the 2015 Amer­i­can’s Health Rank­ings of U.S. states, pub­lished by the United Health Foun­da­tion.

Ana Fuentevilla, M.D., chief med­i­cal o - cer, United Health Care Com­mu­nity and State and spokesper­son for the or­ga­ni­za­tion’s 2016 Health of Women and Chil­dren Re­port, said low health rank­ings over­lap “quite a bit” with high heart dis­ease deaths in south­ern states.

There are long-stand­ing health habits and health­care is­sues in many south­ern states where many are poor and lack ac­cess to health­care, Luep­ker said. “The prob­lems that lead to higher rates in the South are ones that aren’t go­ing to change quickly, cer­tainly not in my life­time or my chil­dren’s life­time.”

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