There are longstanding and pervasive geographic disparities in cardiovascular (CV) health in the US. We sought to evaluate the contemporary trends in CV risk factors by census regions from 2011-2017. The region-specific CV mortality for 2017 was evaluated to assess the geographic overlap between risk factors, CV mortality, and COVID-19 mortality.
The age-adjusted prevalence (per 2010 US census proportions) of CV health index (CVHI) metrics (sum of ideal blood pressure, blood glucose, lipid levels, body mass index, smoking status, physical activity, and diet) (0-7 points), were estimated as both continuous and categorical (ideal, intermediate and poor CVHI) measures in the 2011-2017 BRFSS. Regional trends were evaluated with multivariable-adjusted logistic regression models. Age-adjusted CV mortality for 2017 was derived from the CDC WONDER database. COVID-19 crude mortality rates were ascertained from respective state public health departments.
Among 1,362,529 American adults, the CVHI score increased from 3.89±0.004 in 2011 to 3.96±0.01 in 2017 (P<0.001), modestly improvements in all regions (P<0.05 for all). Ideal CV health prevalence improved only in the northeastern (P=0.03) and southern regions (P=0.002). The CVHI score (3.81±0.01) and prevalence of ideal CV health [2017: 12.2% (95% CI: 11.7-12.7%)] was lowest in southern US. This corresponded with the distribution of CV mortality (per 100,000 persons), which was highest in southern region (233.0 [95% CI: 232.2-233.8]) and lowest in western region (197.5 [95% CI: 19.6-198.5]) (
). State-level distribution of poor CV health did not track with COVID-19 mortality.
Despite a modest improvement in CVHI, only one-in-six Americans have ideal CV health with significant regional and state-level differences that correlate with the geographical distribution of CV mortality but not COVID-19 mortality. These disparities may worsen after the COVID-19 pandemic.