Dramatic geographic variation in heart attack deaths among men explained by University of Pittsburgh researcher at American Heart Association meeting

November 08, 1999

ATLANTA, Nov. 8 -- Differences in smoking patterns and education levels among men in various states may account for wide fluctuations in the cardiovascular disease rates, according to a University of Pittsburgh Graduate School of Public Health (GSPH) study. These findings are being presented Monday, Nov. 8, at the American Heart Association's 72nd Scientific Sessions in Atlanta.

In examining numbers of recorded deaths from coronary heart disease (CHD) in men aged 35-44 in different states and different countries, researchers found a surprisingly wide range of death rates across the United States.

"Up until now, there has been very little research in the United States on geographic variations in CHD mortality in this age group," said Akira Sekikawa, M.D., M.P.H., Ph.D., and principal investigator of the study. "Surprisingly, we found that the numbers of these younger men who die from CHD differ among regions of the United States as much as they differ among countries of the world."

Southern states have the highest rates of CHD deaths, and western states have the lowest numbers. The study also revealed startling differences between CHD mortality in blacks and whites in the United States (44/100,000 men for blacks; 28/100,000 men for whites).

To account for the wide degree of variation among rates of CHD mortality, Dr. Sekikawa and Lewis H. Kuller, M.D., Dr.P.H., chairman, GSPH department of epidemiology, pointed to variations in smoking and education levels, as indicated by records of deaths from cancers of the lung and bronchus and corresponding degree of cigarette smoking, and percentage of high-school graduates.

"The relatively strong correlation between mortality rates from CHD and cancer of lung and bronchus suggests that cigarette smoking is one of the potential candidates in the differences among CHD mortality rates," said Dr. Sekikawa. Similarly, the researchers noticed a moderate correlation between the rates of CHD mortality among men aged 35-44 and rates of high-school graduation.

Quality of emergency medical care was not considered in assessing the numbers of deaths because most of the victims die before help arrives.

"It is unlikely that medical care at the time of the heart attack is a factor in the rate variations," said Dr. Sekikawa.

To demonstrate the differences among states, as well as between blacks and whites, Dr. Sekikawa pointed to statistics showing that CHD mortality rates for southern black men are higher than for men in Poland, a country with one of the top CHD mortality rates (89/100,000 men in Mississippi, 67/100,000 men in Missouri, 63/100,000 men in South Carolina and 54/100,000 men in Poland). Conversely, rates for white men in western states such as Colorado, Utah and Washington rank alongside France (10-20/100,000), which has a relatively low rate as compared with other countries.

Less of a difference is noted in CHD mortality rates between blacks and whites in the east, with states such as New York, New Jersey and Pennsylvania having rates ranging between 25 and 35/100,000 for men of both races.
NOTE TO EDITORS: Akira Sekikawa, M.D., M.P.H., Ph.D., has been selected by the American Heart Association to be available to the media from 4:50 to 5:15 p.m., EST, Sunday, Nov. 7, in the AHA press room. Reporters can call the press room at (404) 222-5002.

University of Pittsburgh Medical Center

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