Background
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, and smoking within and across US counties.
Methods and Results
We conducted a cross-sectional analysis of baseline risk factor measurements and latitude/longitude of participant residence collected from 2003 to 2007 in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. 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: for hypertension, 49% (45 - 58%) among whites and 72% (68 - 78%) among blacks; for diabetes, 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 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.
Conclusions
Geographic disparities in prevalent hypertension, diabetes, and smoking exist within states and within counties in the continental US, and the patterns differ by race.