Shah Hana, Khan Namra, Fernandez Carolina, Perez Ligia, Vaidean Georgeta D
Herbert Wertheim College of Medicine, Florida International University, Miami, USA.
Institutional Transformation Assessment, Gardner Institute, Brevard, USA.
Cureus. 2024 Oct 23;16(10):e72215. doi: 10.7759/cureus.72215. eCollection 2024 Oct.
Extensive research exists on the increased prevalence of cardiovascular disease (CVD) in the "Stroke Belt" states, compared to the remaining United States (U.S.). Social, environmental, and systemic factors and individual behaviors have been investigated, including Black race. This study aims to assess whether residing in the U.S. territories, Stroke Belt, or non-Stroke Belt states is associated with differences in CVD prevalence among non-Hispanic Black adults.
We analyzed cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS). All non-Hispanic Black adults (18+) with complete information on key variables, including demographics, CVD outcomes, and relevant risk factors, were included. The prevalence of CVD was defined as self-reported coronary artery disease, stroke, or myocardial infarction. Univariate and multivariable logistic regression analyses were used to calculate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: Of the 31,246 individuals included in our study, 87 (8.7%) residing in the U.S. territories reported experiencing a cardiovascular event, compared to 1487 (10.1%) in the Stroke Belt and 1872 (8.2%) in the non-Stroke Belt regions. Compared to non-Hispanic Black adults residing outside the Stroke Belt, those living in the Stroke Belt had 23% higher odds of reporting CVD (OR 1.23, 95% CI 1.10-1.44) after adjusting for age and gender. In the fully adjusted model, which accounted for additional factors such as comorbidities and socioeconomic status, the odds were slightly attenuated but remained elevated (OR 1.14, 95% CI 0.97-1.35). For Black adults living in the U.S. territories, the odds of reporting CVD were not significantly different from those outside the Stroke Belt in both the age- and gender-adjusted model (OR 1.07, 95% CI 0.66-1.73) and the fully adjusted model (OR 0.93, 95% CI 0.49-1.74). Independent of residence, individuals with high blood pressure (OR 2.85, 95% CI 2.05-3.96), diabetes (OR 1.45, 95% CI 1.20-1.75), and high cholesterol (OR 1.55, 95% CI 1.27-1.89) had significantly higher odds of CVD. In contrast, smoking and income were associated with prevalent CVD, while self-reported diet, physical activity, and education level were not.
Contrary to our expectation, we found that non-Hispanic Black adults residing in the U.S. territories had similar self-reported CVD with those living in the non-Stroke Belt regions. Further research is needed to investigate the socio-behavioral factors influencing cultural and historical disparities among non-Hispanic Black individuals in the U.S. and its territories.
与美国其他地区相比，关于“中风带”各州心血管疾病（CVD）患病率上升的研究广泛存在。社会、环境和系统因素以及个人行为已被研究，包括黑人种族。本研究旨在评估居住在美国领地、中风带或非中风带各州是否与非西班牙裔黑人成年人的心血管疾病患病率差异相关。
我们分析了2021年行为风险因素监测系统（BRFSS）的横断面数据。纳入所有具有关键变量完整信息的非西班牙裔黑人成年人（18岁及以上），这些变量包括人口统计学、心血管疾病结局和相关风险因素。心血管疾病的患病率定义为自我报告的冠状动脉疾病、中风或心肌梗死。使用单变量和多变量逻辑回归分析来计算粗比值比（OR）和调整后的比值比以及95%置信区间（CI）。结果：在我们研究纳入的31246名个体中，居住在美国领地的87人（8.7%）报告经历过心血管事件，中风带地区为1487人（10.1%），非中风带地区为1872人（8.2%）。与居住在非中风带的非西班牙裔黑人成年人相比，居住在中风带的人在调整年龄和性别后报告心血管疾病的几率高23%（OR 1.23，95% CI 1.10 - 1.44）。在考虑了合并症和社会经济地位等其他因素的完全调整模型中，几率略有降低但仍有所升高（OR 1.14，95% CI 0.97 - 1.35）。对于居住在美国领地的黑人成年人，在年龄和性别调整模型（OR 1.07，95% CI 0.66 - 1.73）和完全调整模型（OR 0.93，95% CI 0.49 - 1.74）中，报告心血管疾病的几率与非中风带地区的人没有显著差异。与居住地点无关，患有高血压（OR 2.85，95% CI 2.05 - 3.96）、糖尿病（OR 1.45，95% CI 1.20 - 1.75）和高胆固醇（OR 1.55，95% CI 1.27 - 1.89）的个体患心血管疾病的几率显著更高。相比之下，吸烟和收入与心血管疾病患病率相关，而自我报告的饮食、身体活动和教育水平则无关。
与我们的预期相反，我们发现居住在美国领地的非西班牙裔黑人成年人自我报告的心血管疾病情况与居住在非中风带地区的人相似。需要进一步研究以调查影响美国及其领地非西班牙裔黑人个体文化和历史差异的社会行为因素。
