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Behavioral Risk Factors and Regional Variation in Cardiovascular Health Care and Death.

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Reducing cardiovascular disease mortality requires focusing on modifiable risk factors like smoking and poor diet, as these strongly correlate with regional death rates. Medical interventions like revascularization showed no association with mortality in this study.

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Area of Science:

  • Cardiovascular disease research
  • Public health
  • Health services research

Background:

  • Cardiovascular disease (CVD) remains a leading cause of death, necessitating strategies for risk reduction and effective medical interventions.
  • Understanding regional variations in CVD mortality is crucial for targeted public health initiatives.

Purpose of the Study:

  • To examine regional variations in behavioral risk factors, health services utilization, and CVD mortality across hospital service areas (HSAs).
  • To investigate the relationships between behavioral risks, cardiac procedure utilization, and CVD mortality rates.

Main Methods:

  • An observational analysis using data from Maine in 2013, covering 606,260 patients aged 35 years and older.
  • HSA-level data on behavioral risks (smoking, diet, physical inactivity) were sourced from the Behavioral Risk Factor Surveillance System.
  • HSA-level data on stress tests, diagnostic cardiac catheterization, and revascularization were obtained from statewide claims data, alongside death certificate data.

Main Results:

  • Significant regional disparities were observed in behavioral risks, including smoking (12.4%-28.6%), poor diet (43.6%-73.0%), and physical inactivity (16.4%-37.9%).
  • After adjusting for behavioral risks, utilization rates for stress tests, diagnostic cardiac catheterization, and revascularization varied considerably across HSAs.
  • Strong associations were found between behavioral risk factors (smoking, poor diet, physical inactivity) and CVD mortality (R² values ranging from 0.35 to 0.57). Revascularization showed no association with CVD mortality after risk factor adjustment (R²=0.02).

Conclusions:

  • Substantial regional variation exists in both behavioral risks and cardiac procedure utilization.
  • Modifiable behavioral risk factors are strongly linked to regional CVD mortality, while revascularization is not.
  • Future efforts to decrease CVD mortality should prioritize prevention strategies targeting modifiable risk factors.