The number of young men who die from heart disease varies
dramatically from state to state, doctors in Pittsburgh reported
Monday. One explanation for higher levels of mortality in certain
states is the higher percentage of cigarette smokers.
Researchers led by Dr. Akira Sekikawa, an epidemiologist at the
University of Pittsburgh School of Public Health, presented the
findings at the American Heart Association's
(http://www.americanheart.org) 72nd Scientific Sessions in Atlanta.
They studied the number of heart-disease deaths in 1994 for men
ages 35 to 44.
Overall, Southern states had the highest rate of death from
heart disease, approaching 50 deaths per 100,000 people. Western
states had the lowest rates, around 15 per 100,000. According to
Sekikawa, most of these men die outside of the hospital, before
medical care can arrive. Therefore, differences in the quality of
medical care across regions were not a factor, he said.
Genetic factors cannot account for the large differences either.
Although genes can contribute to an early death from heart disease,
the genetic makeup of the population in the United States does not
vary greatly by geographic area.
Differences in smoking rates across geographic areas may be one
of the reasons why rates differed, Sekikawa speculated. The states
with the two highest rates of heart-disease mortality were Kentucky
(51 per 100,000 men) and Tennessee (49 per 100,000). These areas
also have very high rates of cigarette smoking.
The investigators found that states with high incidence of lung
cancer also had a high incidence of heart-disease mortality. Those
states with fewer cases of lung cancer also had lower heart-disease
mortality rates, further evidence that smoking is one of the main
factors in the differences in mortality rates among states.
Sekikawa explained that areas with higher numbers of high-school
dropouts also had more heart-disease deaths. ``Socioeconomic status
is one of the important factors when examining mortality from
coronary heart disease,'' Sekikawa said in an interview. Sedentary
lifestyle, obesity, smoking and high blood pressure are all
associated with low socioeconomic status and may be the link
between high-school drop-out rates and heart-disease deaths, he
said.
In addition, the researchers found a significant difference
between the death rates in black and white men ages 35 to 44. Black
men had 44 deaths from heart disease for every 100,000 people. The
rate for white men was 28 per 100,000 people.
This disparity was not apparent in all states, though. New York,
New Jersey, Pennsylvania and Ohio showed little differences in the
mortality rates of whites and blacks. However, blacks in South
Carolina, Tennessee and Kentucky had heart-disease death rates
nearly twice as high as whites in those states. Sekikawa said he
cannot say with certainty what causes this disparity. But he
suggested: ``The same level of mortality is an achievable goal for
each state.''
Sekikawa said he hopes other scientists will help identify the
risk factors that cause this large difference in heart-disease
mortality. ``Public health programs to reduce the risk-factor level
would have a major impact in reducing mortality in this age
group,'' he explained.
Thomas Thom, a statistician in the epidemiology and biometry
program at the National Heart, Lung and Blood Institute
(htp://www.nhlbi.nih.gov) in Bethesda, Md., said that men ages 35
to 44 do not have as many complicating health factors that may
cause death as older groups may. ``I agree it might have been their
lifestyles that played a part in their deaths,'' Thom said.
