Loop Matthew Shane, Howard George, de Los Campos Gustavo, Al-Hamdan Mohammad Z, Safford Monika M, Levitan Emily B, McClure Leslie A
From the Department of Epidemiology (M.S.L., E.B.L.) and Department of Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology & Biostatistics and Department of Statistics & Probability, Michigan State University, East Lansing (G.d.l.C.); Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL (M.Z.A.-H.); Division of General Internal Medicine, Weill Department of Medicine, Weill Cornell Medical College, New York, NY (M.M.S.); and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.).
Circ Cardiovasc Qual Outcomes. 2017 Jan;10(1). doi: 10.1161/CIRCOUTCOMES.116.003350.
Geographic variations in cardiovascular mortality are substantial, but descriptions of geographic variations in major cardiovascular risk factors have relied on data aggregated to counties. Herein, we provide the first description of geographic variation in the prevalence of hypertension, diabetes mellitus, and smoking within and across US counties.
We conducted a cross-sectional analysis of baseline risk factor measurements and latitude/longitude of participant residence collected from 2003 to 2007 in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Of the 30 239 participants, all risk factor measurements and location data were available for 28 887 (96%). The mean (±SD) age of these participants was 64.8(±9.4) years; 41% were black; 55% were female; 59% were hypertensive; 22% were diabetic; and 15% were current smokers. In logistic regression models stratified by race, the median(range) predicted prevalence of the risk factors were as follows: for hypertension, 49% (45%-58%) among whites and 72% (68%-78%) among blacks; for diabetes mellitus, 14% (10%-20%) among whites and 31% (28%-41%) among blacks; and for current smoking, 12% (7%-16%) among whites and 18% (11%-22%) among blacks. Hypertension was most prevalent in the central Southeast among whites, but in the west Southeast among blacks. Diabetes mellitus was most prevalent in the west and central Southeast among whites but in south Florida among blacks. Current smoking was most prevalent in the west Southeast and Midwest among whites and in the north among blacks.
Geographic disparities in prevalent hypertension, diabetes mellitus, and smoking exist within states and within counties in the continental United States, and the patterns differ by race.
心血管疾病死亡率存在显著的地理差异，但对主要心血管危险因素地理差异的描述一直依赖于汇总到县一级的数据。在此，我们首次描述了美国各县内部及各县之间高血压、糖尿病和吸烟患病率的地理差异。
我们对REGARDS研究（卒中地理和种族差异原因研究）中2003年至2007年收集的参与者基线危险因素测量值及居住纬度/经度进行了横断面分析。在30239名参与者中，28887名（96%）的所有危险因素测量值和位置数据均可用。这些参与者的平均（±标准差）年龄为64.8（±9.4）岁；41%为黑人；55%为女性；59%患有高血压；22%患有糖尿病；15%为当前吸烟者。在按种族分层的逻辑回归模型中，危险因素的预测患病率中位数（范围）如下：高血压，白人中为49%（45%-58%），黑人中为72%（68%-78%）；糖尿病，白人中为14%（10%-20%），黑人中为31%（28%-41%）；当前吸烟，白人中为12%（7%-16%），黑人中为18%（11%-22%）。高血压在白人中最常见于东南部中部，但在黑人中最常见于东南部西部。糖尿病在白人中最常见于西部和东南部中部，但在黑人中最常见于佛罗里达州南部。当前吸烟在白人中最常见于东南部西部和中西部，在黑人中最常见于北部。
在美国大陆的州内和县内，高血压、糖尿病和吸烟的患病率存在地理差异，且模式因种族而异。
