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Highest Prevalence of Hypertension Located to Southeastern of United States, 2001-2009

on Thu, 09/05/2013 - 02:43

Introduction

Hypertension or high blood pressure is the most common risk factor for cardiovascular disease worldwide. It is also related to about 18% of deaths from all causes, as well as the majority of deaths from stroke and ischemic heart diseases. According to the Global Burden of Diseases, Injuries and Risk Factors Study 2010 [1] globally, high blood pressure causes more early deaths than any other preventable risk factor, including smoking, obesity, and childhood malnutrition. It is also ranked as the first leading risk factor contributing to disability, affecting both men and women.

Hypertension increases the risk of myocardial infarction, stroke, and kidney failure and it can also cause blindness and heart failure. The risk of developing any of these complications is higher if hypertension is not controlled, for instance, if it is not less than 140/90 mmHg and if other risk factors such as tobacco, obesity, and diabetes exist.

In the United States, high blood pressure is responsible for one in six deaths having one out of three adults suffering from this condition. It is the fourth leading risk factor for disability adjusted life years (DALYs) in the population of all ages and both sexes in 2010 [2].  

For public health and health policy, assessing the level, distribution and trends of the prevalence of hypertension including person, space and time dimensions allows a better understanding of this risk factor, define interventions and evaluate their effectiveness, and monitor the progress in reducing the burden of high blood pressure in the population.

This article describes the level, distribution and trends of the prevalence of hypertension in United States of America at states and county levels, by gender and race in 2001 and 2009. An exploratory data visualization is proposed as a tool for assessing hypertension, monitoring progress of reducing the burden of hypertension at national, state and local levels and providing useful information to public health decision-maker, policy makers and the general public.    

Methods

Estimates of prevalence of hypertension in United States by sex, race, county and years 2001 and 2009 were used as data source for the analysis [3]. This data set is a result of the study on conducted by Olives C et al [4] and is available online in the GHDx repository.

To the effect of the present analysis, hypertension was defined as systolic blood pressure of at least 140 mmHg, self-reported use of antihypertensive treatment, or both. Race/ethnicity was determined by self-report and grouped as non-Hispanic white (white), non-Hispanic black (black), Hispanic, and other (American Indian, Native Alaskan, Asian or Pacific Islander, and other race not specified).

Estimates of age-standardized prevalence of total hypertension, expressed in percentage, by sex and race among 30 years and older was the measure use in the analysis, and breakdown by state and county, sex, race and year. 

The data visualization was designed including three linked charts, two maps, at state and county levels, and a dot plot showing the level and distribution of hypertension by states and counties. Data can be filter and selected by sex, race and years. Some actions were implemented to facilitate data exploration, ask new questions and for a better user experience. The data visualization serves as exploratory tool to assess the magnitude, geographic distribution and trend of hypertension in both state and county levels.

Key findings

The median prevalence of hypertension in 2001 was estimated at 32.6% in men and 36.9% in women, meanwhile those values increase to 37.6% and 40.1% respectively in 2009, a rising of 5% in men and 3.2% in women. This increase is presumable a consequence of the improvement of prevention and control programs at state and local levels in US.

Total hypertension prevalence exhibits a strong geographic trend with a cluster of high burden localized to southeastern states, including Mississippi, District of Columbia, South Carolina, Louisiana and Georgia as the top five states with higher hypertension in 2009. Geographic trends in total prevalence is similar across sex and race categories.

There is a high heterogeneity in the distribution of hypertension at both state and county levels. Across States, Mississippi has the higher hypertension with 45% and Colorado the lower, 33.9%, having a difference of 11.1 percentage points in males in 2009. At county level this difference is higher, having Eagle County, Colorado with the lower hypertension of 26.5% and Mississippi County, Mississippi with the higher hypertension of 54.4% for 27.9 percentage points of difference. 

There is a visible high disparity in hypertension prevalence within states such as Georgia, Alabama and Virginia. These disparities should be addressed by public health analysts at state and county levels to find potential causes of the problem and orient interventions.

Crowley County, Colorado with a very high prevalence of hypertension of 44.0% surrounded by counties with low values, and located in Colorado, the state with the lower hypertension prevalence is a clear outlier. This situation is consistent in year 2001 and 2009.  This specific case deserves an in-depth analysis in order to find factors contributing to it. 

This high heterogeneity of hypertension prevalence is consistent across sex, race and years.

Prevalence of hypertension is consistently higher in women than men across race groups and over time.

Black men and women had the highest total prevalence of hypertension, with median prevalence of 50.8% (range: 38.7% to 60.9%) in men and 54.4% (range: 41.8 to 64.2%) in women aged 30 and older in 2009. Median county prevalence of hypertension increased in both genders and all race categories between 2001 and 2009. 

Conclusions

The assessment of hypertension prevalence at national and local levels provides relevant information for priority settings, health planning and evaluation of public health interventions.

States and county Health authorities and healthcare should be aware of the situation and trends of hypertension in order to take appropriate actions and interventions to reduce the burden of hypertension, rise awareness, treatment, and blood pressure control.

Data visualizations are powerful tools for assessing hypertension and monitor progress of reducing the burden of hypertension at national, sub-national and local levels, and disseminate information to the general public.

References

  1. Institute of Health Metrics and Evaluation. Global Burden of Diseases, Injuries and Risk Factors Study 2010. Visualizations: GBD 2010 change in leading causes and risks between 1990 and 2010. Available online
  2. Institute of health Metrics and Evaluation. Global Burden of Disease, Injuries and Risk Factors Study 2010. Visualization: GBD Arrows
  3. Institute for Health Metrics and Evaluation (IHME). United States Hypertension Estimates By County 2001-2009. Seattle, United States: Institute for Health Metrics and Evaluation, 2013.
  4. Olives C, Myerson R, Mokdad AH, Murray CJL, Lim SS. Prevalence, awareness, treatment, and control of hypertension in United States counties, 2001-2009. PLoS ONE. 2013;8(4);e60308.

P.S. The visualization of this article was selected by Tableau Public as Visualization of the Day on September 6th, 2013.

Tableau Public Visualization of the Day, January 15th, 2013

Comments

Linda Pickle's picture

This is an interesting and effective visualization of the prevalence of hypertension. However, your blog post calls this an example of interactive Linked Micromaps. Linked Micromaps, developed by Dan Carr of George Mason University, are a series of small maps linked to rows of geography-specific graphics. This design allows the user to sort by any of the linked variables, for example to look visually for correlations between the sorted column and others, and to look for clusters of similar values on the small maps. What you have here is a single map (either state or county) linked by color to a single dot chart, not linked micromaps. For an example of Linked Micromaps, see http://www.statnetconsulting.com/micromaps.html for a sample, http://mason.gmu.edu/~dcarr/Micromaps/ for code to reproduce examples from our book (Carr and Pickle, 2010), and http://statecancerprofiles.cancer.gov/micromaps/ for an interactive version that displays cancer data. An R package, micromapST, is also available on CRAN.

kamm's picture

Do we know anything about the cause yet? Is it because these people have a more stressfull lifestyle, is it because of the temperature, what could cause this? If we knew [more] about these things we could come up with effective solutions for the people that are more exposed to heart failure risk.

martiner's picture

Hypertension is related to multiple factors, including diet, harmful use of alcohol, lifestyle and low physical activity. Socio-economics conditions are also strong determinants of hypertension, such as education, poverty, access to healthcare.  

Hypertension can be prevented by reducing salt intake, following a healthy balanced diet, avoiding the harmful use of alcohol, maintaining a physically active lifestyle, and a healthy body weight. It can be treated successfully if you follow the recommendations of your doctor and use safe medications.

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