Differences between Arkansas and the United States in Prevalence of Risk Factors Explain Variations in Ischemic Heart Disease Mortality Rates among Pre-Medicare (45-64) and Medicare (65-84) Age Groups

Arkansas (AR) consistently has higher ischemic heart disease (IHD) death rates than the US, which is believed to be due to a higher prevalence in AR of major, modifiable risk factors. We examined the difference in IHD death rates between AR and the US as consequences of differences in the prevalence of nine risk factors between pre-Medicare age group (45-64) and Medicare age group (65-84). We modeled IHD deaths attributable to differential prevalence between AR and the US using mortality data and prevalence data from AR and US for years 2000-2010, and relative risk measures obtained from the INTERHEART and Atherosclerosis Risk in Communities studies. From 2000-2010, our study showed that if we were to reduce the prevalence of significant risk factors to US levels, we would reduce AR IHD deaths by 26.6% in the pre-Medicare age group and 15.9% in the Medicare age group. Most of the increased mortality was explained by higher prevalence of smoking and hypertension in AR. Other socioeconomic factors that contributed to an increased risk of poor health outcomes were education, income, and the lack of health insurance; with AR having worse outcomes than the US for the pre-Medicare age group. The importance of risk factors depended on race, sex, and age. The excess mortality in AR relative to the US for the two age groups can largely be explained by prevalence differences in smoking, hypertension, cholesterol, education and income.