 |
|
|
|
|
Women's Heart Disease Atlas: Table
of Contents
Source: Casper ML, Barnett E, Halverson JA, Elmes GA, Braham VE, Majeed ZA,
Bloom AS, Stanley S. Women and Heart Disease: An Atlas of Racial and Ethnic
Disparities in Mortality, Second Edition. Morgantown, WV: Office for Social
Environment and Health Research, West Virginia University, 2000.
Note: Information is presented as at the time of publication. Some reference,
resource and contact information may not be current.
Women and Heart Disease: An Atlas of Racial and
Ethnic Disparities in Mortality
Second Edition
Michele L. Casper, Elizabeth Barnett, Joel A. Halverson, Gregory A.
Elmes, Valerie E. Braham, Zainal A. Majeed, Amy S. Bloom, Shaun Stanley.
Office for Social Environment and Health Research • West Virginia
University • National Center for Chronic Disease Prevention and Health
Promotion • Centers for Disease Control and Prevention
A Message from the Director of the Centers
for Disease Control and Prevention
December 1999
As the Nation's Prevention Agency, the Centers for Disease Control
and Prevention (CDC) is committed to reducing the burden of heart disease—the leading cause of death and a major contributor to disability in
the United States. Deaths from heart disease are largely preventable, and
with targeted public health efforts we can alleviate much of the heavy
burden of this disease. To meet this challenge, CDC works to closely
monitor geographic and temporal trends in heart disease among racial and
ethnic groups, strengthen the delivery of primary and secondary preventive
health services to all such groups, and implement policy changes that
support heart–healthy environments for all residents of the United States.
CDC's Associate Director for Women's Health and Associate Director for
Minority Health serve as the Agency's focal points for coordinating
activities and monitoring programs to meet these objectives.
Among women, mortality rates for heart disease are higher than the
rates for all forms of cancer combined. Approximately 373,286 women die of
heart disease each year, and more than 6.5 million women alive today have
suffered a heart attack or angina pectoris (chest pain). In addition, the
burden of heart disease among women is not equally distributed among
racial and ethnic groups within the United States. Women and Heart
Disease comprehensively describes the unequal distribution of heart
disease among these groups.
Women and Heart Disease: An Atlas of Racial and Ethnic Disparities
in Mortality provides health professionals and concerned citizens at
the local, State, and national levels with information essential to
identifying populations of women at greatest risk of heart disease and in
greatest need of prevention efforts. For the first time, county–level maps
of heart disease are presented for women of the five largest racial and
ethnic groups in the United States—American Indians and Alaska
Natives, Asians and Pacific Islanders, Blacks, Hispanics, and Whites. In
addition, Women and Heart Disease includes maps that depict geographic
patterns of local economic and medical care resources, data on the social
isolation of women, and population distributions for each racial and
ethnic group. These maps provide crucial information for tailoring
prevention efforts to the communities in need.
This publication is the first in a series of atlases related to
cardiovascular disease that are in progress through a collaboration
between CDC and West Virginia University. The next publication will be Men
and Heart Disease: An Atlas of Racial and Ethnic Disparities in Mortality.
I am pleased to share this important publication with you. I encourage
you to use these data to improve the delivery of preventive health
services and to create heart–healthy environments for all women.
[signature]
Jeffrey P. Koplan, M.D., M.P.H.
Director, Centers for Disease Control and Prevention
Back to
top
A Message from the Associate Director for
Women's Health and the Associate Director for Minority Health of the
Centers for Disease Control and Prevention
December 1999
There is an increasing awareness of the health needs of women and
minority populations in the United States. Historically, both groups have
had limited access to health care resources and have been omitted from
many research studies. Government and nongovernment health agencies are
beginning to identify the gaps in health care and health outcomes that
exist among these groups and are beginning to develop strategies to reduce
these gaps. Since the inception of the Centers for Disease Control and
Prevention's (CDC) Office of Minority Health in 1988 and Office of Women's
Health in 1994, our Offices have been committed to improving the health
status of women and of racial and ethnic minority populations throughout
the United States.
CDC's Office of Women's Health is preparing to address the
projected demographic trends of the next century and to meet the current
and anticipated needs of millions of underserved women in America. By the
year 2030, one of every four women will be over the age of 65, and by the
year 2050 women of color will represent one–half of the adult female
population. These trends toward the aging and diversification of American
women highlight the need to establish health promotion policies and
programs that are culturally relevant and address issues surrounding
chronic diseases that an aging population will experience—particularly
heart disease, the leading cause of death among women in the United
States. The data presented in Women and Heart Disease: An Atlas of
Racial and Ethnic Disparities in Mortality, provides for the first
time, vital information needed to locate communities of women at greatest
risk of heart disease for each racial and ethnic group. The county–level
maps of heart disease and social environmental conditions provide the
basis for taking actions now that could lead to substantially lower rates
of heart disease among all U.S. women in the future.
A central focus of activities of CDC's Office of Minority Health is
implementation of the President's Initiative to Eliminate Racial and
Ethnic Disparities in Health. Cardiovascular disease is one of the six
health status areas targeted for eliminating such disparities by the year
2010. We recognize that achieving this goal requires a major national
commitment to identify and address the underlying causes of the racial and
ethnic disparities. New insights are needed to understand the determinants
of the racial and ethnic disparities in cardiovascular disease and to
apply our knowledge toward eliminating these gaps. In this regard, you
will find Women and Heart Disease: An Atlas of Racial and Ethnic
Disparities in Mortality to be a timely publication that provides a
new perspective on the racial and ethnic patterns of cardiovascular
disease at the community level. The maps will enable health researchers to
develop new hypotheses regarding the determinants of the geographic
patterns of heart disease for each racial and ethnic group, and will also
enable health professionals in local, State, and national health agencies
to design new programs and policies tailored to the needs of the
communities with the highest rates of heart disease mortality.
As we continue to identify the health needs of women and minority
populations, additional opportunities will arise to expand and modify our
public health and medical care strategies for preventing and treating
heart disease among all women.
[signature]
Karen K. Steinberg, Ph.D.
Acting Associate Director for Women's Health
[signature]
Walter W. Williams, M.D., M.P.H.
Associate Director for Minority Health
Back to
top
Foreword
December 1999
I am pleased to present Women and Heart Disease: An Atlas of Racial
and Ethnic Disparities in Mortality. For too long, heart disease has
been considered as primarily a "man's disease"; however, heart
disease is also the number one killer of women. In terms of total deaths,
heart disease claims the lives of more women than men. The gap between
women and men is growing as the number of excess deaths from heart disease
among women continues to increase over time.
This landmark document supports the President's Initiative to
Eliminate Racial and Ethnic Disparities in Health and addresses the
important need to reduce the risk of heart disease among women of all
racial and ethnic groups. The maps in Women and Heart Disease
depict heart disease mortality rates among women, county–by–county, for
the entire United States, and identify the places where women of each of
the five major racial and ethnic groups experience the highest rates of
mortality from heart disease. With this information, public health
professionals at the local, state, and national levels will be able to
target prevention resources to populations of women in greatest need of
additional services.
Although mortality from heart disease has been declining for several
decades, the rate of decline has varied by racial and ethnic group,
resulting at times in a widening of the gap between such groups for both
women and men. Moreover, recent trends indicate a slowing down in the rate
of decline of heart disease mortality and underscore the importance of
enhancing our efforts to support innovative community–based strategies for
reducing the risk of heart disease. For women of all racial and ethnic
groups (as well as for men) it is through prevention that we can expect to
achieve the greatest cardiovascular health benefits. Women and Heart
Disease indicates where those programs are most needed and can have
the greatest benefit.
It is my hope that Women and Heart Disease: An Atlas of Racial and
Ethnic Disparities in Mortality will be used to guide the distribution
of funds and resources to those communities of women experiencing excess
mortality from heart disease and will promote the development of
culturally sensitive prevention strategies.
[signature]
James S. Marks M.D., M.P.H.
Director, National Center for Chronic Disease Prevention and Health
Promotion
Centers for Disease Control and Prevention
Back to
top
Table of Contents
| A Message from the Director
of the Centers for Disease Control and Prevention |
iii |
| A Message from the Associate
Director for Women’s Health and the Associate Director for
Minority Health of the Centers for Disease Control and Prevention |
v |
| Foreword by James S. Marks,
M.D., M.P.H. |
vii |
| List of Figures |
xiii |
Introduction
|
15 |
| Section 1. Racial and
Ethnic Disparities in Heart Disease Among Women |
19 |
| The Social Construction of
Race |
20 |
| Misreporting of Race and
Ethnicity on Death Certificates |
21 |
| Specific Categories of Heart
Disease Deaths Among Women |
22 |
| Age Distribution of Heart
Disease Deaths Among Women |
22 |
| Heart Disease Death Rate
Trends for 1991–1995 |
23 |
County Variation in Heart
Disease Death Rates
|
23 |
| Section 2. Reader's
Guide to Understanding and Interpreting the Maps |
27 |
| Calculation of Heart Disease
Death Rates |
28 |
| National Heart Disease
Mortality Map Layouts |
29 |
| National Map Projections |
29 |
| Scale of the National Maps |
30 |
| Guide to National Maps of
Local Social Environment |
30 |
| National Population
Distribution Map Layouts |
31 |
| Guide to State Maps of Heart
Disease Mortality |
31 |
| State Map Layouts |
32 |
| State Map Projections |
32 |
Scale of the State Maps
|
33 |
| Section 3. Local Social
Environment and Women's Risk for Heart Disease Mortality |
35 |
| Population Distributions |
39 |
| Local Economic Resources |
51 |
| Social Isolation of Elderly
Women |
55 |
Medical Care Resources
|
61 |
Section 4. National Maps
of Heart Disease Mortality among Women
|
69 |
| Section 5. State Maps of
Heart Disease Mortality among Women |
85 |
| Alabama |
88 |
| Alaska |
90 |
| Arizona |
92 |
| Arkansas |
94 |
| California |
96 |
| Colorado |
98 |
| Connecticut |
100 |
| Delaware |
102 |
| District of Columbia |
104 |
| Florida |
106 |
| Georgia |
108 |
| Hawaii |
110 |
| Idaho |
112 |
| Illinois |
114 |
| Indiana |
116 |
| Iowa |
118 |
| Kansas |
120 |
| Kentucky |
122 |
| Louisiana |
124 |
| Maine |
126 |
| Maryland |
128 |
| Massachusetts |
130 |
| Michigan |
132 |
| Minnesota |
134 |
| Mississippi |
136 |
| Missouri |
138 |
| Montana |
140 |
| Nebraska |
142 |
| Nevada |
144 |
| New Hampshire |
146 |
| New Jersey |
148 |
| New Mexico |
150 |
| New York |
152 |
| New York City |
154 |
| North Carolina |
156 |
| North Dakota |
158 |
| Ohio |
160 |
| Oklahoma |
162 |
| Oregon |
164 |
| Pennsylvania |
166 |
| Rhode Island |
168 |
| South Carolina |
170 |
| South Dakota |
172 |
| Tennessee |
174 |
| Texas |
176 |
| Utah |
178 |
| Vermont |
180 |
| Virginia |
182 |
| Washington |
184 |
| West Virginia |
186 |
| Wisconsin |
188 |
Wyoming
|
190 |
| Appendix A. State
Rankings of Heart Disease Mortality Among Women |
193 |
| Appendix B.
Methodological and Technical Notes |
207 |
| Appendix C.
Resources |
219 |
| Index |
233 |
| About the Authors |
239 |
List of Figures
|
|
Figure 1.1
Specific categories of heart disease deaths among women 35 years of
age and older, by race and ethnicity, 1991–1995 |
20 |
Figure 1.2
Age distribution of heart disease deaths among women 35 years of age
and older, by race and ethnicity, 1991–1995 |
21 |
Figure 1.3
Trends in heart disease mortality among women 35 years of age and
older, by race and ethnicity, 1991–1995 |
22 |
Figure 1.4
Frequency distribution of smoothed county heart disease death rates
for women 35 years of age and older, by race and ethnicity,
1991–1995 |
23 |
Figure 2.1
Example of layout for national heart disease mortality maps |
30 |
Figure 2.2
Example of layout for national population distribution maps |
31 |
Figure 2.3
Example of layout for state heart disease mortality maps |
33 |
Figure 3.1
Asian Populations in the United States,1990 |
42 |
Figure 3.2
Hispanic Populations in the United States,1990 |
46 |
Figure 4.1
Frequency Distribution of Smoothed Heart Disease Death Rates for
Counties, All Women, 1991–1995 |
72 |
Figure 4.2
Frequency Distribution of Smoothed Heart Disease Death Rates for
Counties, American Indian and Alaska Native Women, 1991–1995 |
74 |
Figure 4.3
Frequency Distribution of Smoothed Heart Disease Death Rates for
Counties, Asian and Pacific Islander Women, 1991–1995 |
76 |
Figure 4.4
Frequency Distribution of Smoothed Heart Disease Death Rates for
Counties, Black Women, 1991–1995 |
78 |
Figure 4.5
Frequency Distribution of Smoothed Heart Disease Death Rates for
Counties, Hispanic Women, 1991–1995 |
80 |
Figure 4.6
Frequency Distribution of Smoothed Heart Disease Death Rates for
Counties, White Women, 1991–1995 |
82 |
Back to
top
Date last reviewed:
05/12/2006
Content source: Division for Heart Disease and Stroke
Prevention,
National Center for Chronic Disease Prevention and
Health Promotion
|
|
