2012
ARKANSAS
HEART DISEASE AND STROKE REPORT
A SNAPSHOT OF CARDIOVASCULAR DISEASES IN ARKANSAS
Prepared for the Arkansas Minority Health Commission by:
Jennifer Maulden, MA
Martha M. Phillips, PhD
TABLE OF CONTENTS
Introduction ................................................................................................................................................ 3
Prevalence ................................................................................................................................................... 4
Mortality ......................................................................................................................................................5
Disparities in Mortality ............................................................................................................................... 6
Costs of Care ................................................................................................................................................7
Risk Factors
Obesity ............................................................................................................................................ 8
Lack of Physical Activity ................................................................................................................ 9
Poor Diet ........................................................................................................................................10
Smoking ......................................................................................................................................... 11
Diabetes ......................................................................................................................................... 12
Preventive Care .......................................................................................................................................... 13
Access to Care ............................................................................................................................................ 14
References .................................................................................................................................................. 16
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INTRODUCTION
Heart disease is the leading cause of death in Arkansas, resulting in the death of 22,085 people from 2008
to 2010. Stroke is another leading cause, with 5,157 deaths during the same time period. As shown in the
table below, mortality rates for the top ten causes of death are higher in Arkansas than they are nationally.1
This would suggest that despite the fact that heart disease and stroke have devastating effects nationwide,
they may be cause for greater concern here in the state.
This report discusses the burden of heart disease and stroke in Arkansas, with a goal of shedding light on
high risk populations and areas that may be addressed to reduce the burden in Arkansas’ citizens.
Rank
1
2
3
4
5
6
7
8
9
10
Condition
Heart Disease
LEADING CAUSES OF DEATH,
ARKANSAS 2008 - 20101
Arkansas Deaths
Arkansas
Age-Adjusted Rate
per 100,000 People
22,085
228.2
U.S.
Age-Adjusted Rate
per 100,000 People
184.6
Cancer
19,514
198.1
174.2
Chronic Lower Respiratory Disease
5,491
56.1
43.2
Stroke
5,157
53.7
40.2
Unintentional Injury
4,411
50.0
38.2
Alzheimer’s Disease
2,733
28.6
25.0
Diabetes Mellitus
2,641
27.1
21.3
Influenza & Pneumonia
2,198
22.9
16.4
Nephritis
2,055
21.3
15.2
Septicemia
1,525
15.8
10.9
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PREVALENCE
Source: Behavioral Risk Factor Surveillance System, 20102
Heart disease is a class of diseases
which includes many different
conditions, including disease in the
arteries leading to and from the heart
(coronary artery disease), chest pain
(angina), and irregular heartbeats
(arrhythmias).3
A stroke, on the other hand, occurs
when either: a) blockage in the
arteries prevents blood from reaching
the brain or b) an artery in the brain
ruptures. Regardless of the cause,
strokes can have devastating effects
on a person, ranging from brain
damage to death.4
To understand the burden of these
conditions in Arkansas, it is helpful to
understand the number of people
living with the condition and its
related outcomes.
Since 2005, Arkansans have shown
higher prevalence rates for coronary
heart disease, stroke, and heart
disease compared to the national
median rates.
Coronary heart disease rates have
increased slightly for Arkansans since
2005, while decreasing slightly
nationwide.
Similarly, rates of stroke and heart
attack have increased slightly for
Arkansas while remaining steady
nationally.2
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MORTALITY
Source: CDC Wonder1
As evidenced by the chart on the left,
deaths from coronary heart disease
made up the majority of
cardiovascular disease deaths (51%)
in Arkansas from 2006 to 2010.
Deaths due to stroke made up 18% of
cardiovascular disease deaths, and
heart failure made up 8%.
In addition, since 2000, mortality
rates from heart disease and stroke
have been steadily decreasing – in
2000, the age-adjusted mortality rate
of heart disease was 284.5 deaths per
100,000 people, and in 2009 the rate
had dropped to 228.2 per 100,000.
Similarly, the mortality rate for stroke
decreased from 77.2 deaths per
100,000 people in 2000 to 53.7 per
100,000 in 2009.
Mortality Rates in
Arkansas
Age Adjusted Mortality Rate
(per 100,000 people)
3 year moving rates
300
250
284.5
228.2
200
150
100
50
77.2
53.7
Despite these drops in mortality
rates, heart disease and stroke remain
a serious public health issue for
Arkansas, resulting in thousands of
deaths ever year.
0
heart disease
stroke
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DISPARITIES IN MORTALITY
Source: Arkansas Department of Health, 2005 – 20095
From 2005 to 2009, the age-adjusted death rate for heart disease was higher among African
Americans (291 deaths per 100,000) than for Whites (225 per 100,000); Latinos had a significantly
lower rate (78 per 100,000). This same pattern held for stroke mortality, with African Americans
showing higher rates of death (85 per 100,000) compared to Whites and Latinos.
Years of potential life lost is another way to measure mortality, as it measures premature mortality
(before age 75) due to death from a disease. On average, from 2005 – 2009, African Americans lost
more potential years due to heart disease – in other words, they died at younger ages - compared to
Whites and Latinos. A similar pattern was found for stroke, with evidence showing that Blacks die
younger than Whites and Latinos.
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COSTS OF CARE
Source: U.S. Department of Human Services Healthcare Cost and Utilization Project, 20106
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
DISCHARGES AND COSTS BY PRINCIPAL MEDICAL DIAGNOSIS,
ARKANSAS 2010
Principal Diagnosis
Total # of
discharges
Coronary atherosclerosis*
11,290
Aggregate costs
(in Millions)
162
Septicemia
8,701
120
Pneumonia
15,071
111
Osteoarthritis
8,638
101
Respiratory failure
4,468
100
Heart attack*
6,596
99
Heart failure*
11,219
92
Complication of device, implant, or graft
6,208
87
Liveborn
37,235
80
Rehabilitation Care
8,311
72
Cardiac Dysrhythmias*
8,357
68
Spondylosis, Intervertebral Disc Disorders, other back problems
6,392
62
Stroke*
6,266
54
Chronic Obstructive Pulmonary Disease
8,892
52
Complications of Surgical Procedures or Medical Care
4,688
52
Healthcare costs provide another way to quantify the burden of a particular disease or condition. In
2010, the most costly condition in Arkansas was coronary atherosclerosis (hardening of the arteries) just 11,290 hospital discharges with this principal diagnosis totaled $162 million. Heart attack, another
serious potential outcome related to heart disease, was the 6th most expensive diagnosis, with 6,596
discharges costing $99 million. Three other cardiovascular diagnoses appear in the top 15 for the state,
including heart failure (7th at $92 million), cardiac dysrhythmias (11th at $68 million), and stroke (13th at
$54 million). Together, these five conditions account for an estimated $475 million in costs arising from
43,728 hospital discharges.
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RISK FACTORS – OBESITY
Source: Behavioral Risk Factor Surveillance System, 20112
Overweight
Obesity is one of the leading risk factors for heart
disease and stroke. Body Mass Index (BMI),
calculated as a ratio of weight and height, is used
to assess an individual’s weight status.
In 2011, 65% of Arkansans reported being
overweight or obese. Generally, proportions of
persons who are overweight or obese tended to
increase with age; fewer persons 65 and older,
however, were obese than younger persons.
Comparing racial and ethnic groups, a larger
proportion of Latinos were overweight compared
to their White and African American
counterparts, and African Americans showed
higher rates of obesity than did Whites or
Latinos.
Males were more likely to be overweight than
women while both groups showed similar rates
of obesity.
Overweight and Obesity
by Race / Ethnicity
Arkansas, 2011
Overweight and Obesity by Gender
Arkansas, 2011
47%
50%
33% 35%
25%
White
38%
31%
50%
Black
19%
Latino
39%
29%
31% 31%
Male
25%
Female
0%
0%
Overweight
Obese
Overweight
Obese
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RISK FACTORS – LACK OF PHYSICAL ACTIVITY
Source: Behavioral Risk Factor Surveillance System, 20112
Low levels of physical activity have also been
associated with an increased risk for heart
attack and stroke. In 2011, a majority of
Arkansans reported not engaging in least
150 minutes of aerobic physical activity a
week.
Data also revealed that the proportion of
adults who reach recommended levels of
exercise peaks in the 18 to 24 age group,
reaches a low point among 45 to 54 year
olds, and increases afterward with age.
Racial and ethnic differences were slight,
though African Americans showed the
highest level of compliance with
recommendations compared to Whites and
Latinos.
Data showed little evidence of gender
differences as well, with only a slightly
higher proportion of females reporting
sufficient physical activity compared to
males.
Adults Reaching Recommended
Levels of Physical Activity,
by Race / Ethnicity
Arkansas, 2011
Adults Reaching Recommended Levels
of Physical Activity, by Gender
Arkansas, 2011
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RISK FACTORS – POOR DIET
Source: Behavioral Risk Factor Surveillance System, 20092
Another risk factor for heart disease and
stroke is poor diet. In 2009, only one of every
five adults consumed at least 5 servings of
fruits and vegetables per day.
Across age groups, the proportion of adults
consuming the recommended number of
servings of fruits and vegetables per day was
relatively constant, with a slight increase
among those 65 and older.
No differences among racial/ethnic groups
were observed.
However, a larger proportion of females
consumed the recommended amount of fruits
and vegetables compared to males.
Adults Consuming Fruits and Vegetables
5 or More Times per Day,
by Race / Ethnicity
Arkansas, 2009
Adults Consuming Fruits and Vegetables
Less than 5 Times per Day, by Gender
Arkansas, 2009
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RISK FACTORS - SMOKING
Source: Behavioral Risk Factor Surveillance System, 20112
Smoking is another risk factor for developing
heart disease or stroke. In 2011, approximately
half of Arkansans reported they never smoked.
However, one out of four Arkansas adults
reported themselves to be current smokers.
Proportions of smokers vary markedly by age
group, with peaks in the 25 to 34 group and
the 45 to 54 age group. Rates drop
substantially among those 65 years of age and
older.
While an equal percentage of Whites and
African Americans are current smokers, rates
among Latinos are significantly lower.
In addition, the proportion of smokers among
women is nearly the same as the proportion
among men (3 of every 10).
Adults Who Are Current Smokers,
by Race / Ethnicity
Arkansas, 2011
Adults Who Are Current Smokers,
by Gender
Arkansas, 2011
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RISK FACTORS - DIABETES
Source: Behavioral Risk Factor Surveillance System, 20102
Having diabetes greatly increases one’s risk of
having a heart attack stroke. In 2010,
approximately 1 of every 10 Arkansans had been
told they had diabetes.
The proportion of adults ever told they had
diabetes increases with age, with proportions
ranging from 0 among 18 to 24 year olds to 20%
among those 65 years of age and older.
In addition, African Americans were more likely
to have diabetes than Whites and Latinos.
There were no differences between men and
women with regard to having a diabetes
diagnosis.
Adults Who Have Ever Been Told They
Have Diabetes, by Race
Arkansas, 2010
Adults Who Have Ever Been Told They
Have Diabetes, by Gender
Arkansas, 2010
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PREVENTIVE CARE
Source: Behavioral Risk Factor Surveillance System, 20112
Adults' Cholesterol Check Status, 2011
Preventive care is a key component in reducing risk of heart disease and stroke. In 2011, one quarter of all
adult Arkansans reported that they had never had their blood cholesterol levels checked. Whites and African
Americans were similar in the proportions within each group reporting no cholesterol checks.
Four of every 10 Arkansans reported that having been told their cholesterol level was high, a proportion that
is similar to that found nationally. White Arkansans were more likely to have been told their levels were
high, compared to black Arkansans.
Regarding high blood pressure, more than one third of adults in Arkansas reporting having been told their
blood pressure was high, a proportion that is somewhat higher than the national rate of 31%. Rates were
slightly higher among African Americans in Arkansas than among Whites; rates among Latinos were
significantly lower than among the two other groups.
Adults Who Have Been Told They Have
High Blood Pressure
Arkansas, 2011
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ACCESS TO CARE
Sources: Arkansas Department of Health Workforce Data, 20117 & Small Area Health Insurance Estimates, 20118
PERCENT AGED 0 – 64 UNINSURED BY COUNTY, 2011
Prevention and treatment of
heart disease and stroke are not
possible without access to
affordable health care.
Unfortunately, that access is not
equally available to all citizens
of the state.
In 2011, in every Arkansas
county more than 15% of its
population under 65 years of
age was uninsured. In 12
counties, primarily in the
western part of the state, more
than one out of every four
residents did not have
insurance and in 1 county
(Sevier County) nearly one third
of the population was
uninsured.
= 15% - 19% uninsured
= 20% - 24% uninsured
= 25% - 29% uninsured
= 30% + uninsured
3103

Located in 74 counties
Licensed Primary Care
Physicians

32% located in Pulaski County

1 county has no primary care physicians:
Cleveland

Located in just 16 counties

Most active county: Pulaski (50)

59 counties have no cardiologists

Located in just 16 counties

Most active county: Pulaski (79)

59 counties have no neurologists
117
Licensed
cardiologists
159
Licensed
neurologists
In addition, physicians are not
equally distributed across the
state. In 2011, nearly a third of
the primary care physicians in
the state were located in a
single county (Pulaski County,
in which 13% of the state’s
population resides), and one
county (Cleveland County) had
no primary care physicians at
all. With regard to specialty
care, the state is home to 117
cardiologists, who are located in
just 16 of the 75 counties.
Similarly, 159 neurologists were
working in Arkansas, with more
than half of them (79)
practicing in Pulaski County.
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ACCESS TO CARE
Source: Health Resources and Services Administration, 20119
MEDICALLY UNDERSERVED AREAS - 2011
= No Designation
= Partial Designation
= Full Designation
The Health Resources and Services Administration (HRSA) designates counties as medically
underserved based on various criteria, including the ratio of primary medical care physicians to the
population, infant mortality rate, poverty level, and age distribution. Counties can have a partial
designation (indicating that only certain areas of the county are underserved), a full designation
(meaning the entire county is underserved), or no designation (meaning the county is adequately
medically served).
In 2011, two counties received no designation, Boone and Grant. Fourteen counties received partial
designations, and the other 59 counties received full designations. This underscores a serious issue for
those needing medical services in the state, whether for heart disease or any other condition, and
signals a clear area for improvement.
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References
1.
CDC Wide-ranging Online Data for Epidemiologic Research (WONDER), 2008 - 2010. Available
from: http://wonder.cdc.gov/.
2.
National Center for Chronic Disease Prevention and Health Promotion, 2012. Heart Disease.
Centers for Disease Control and Prevention. Available from:
http://www.cdc.gov/heartdisease/index.htm.
3.
Behavioral Risk Factor Surveillance System, 2006 – 2011. Available from:
http://www.cdc.gov/brfss/.
4.
National Heart Lung and Blood Institute, 2011. Stroke. Available from:
http://www.nhlbi.nih.gov/health/health-topics/topics/stroke/.
5.
Health Statistics Query System, 2005 - 2009. Arkansas Department of Health. Available from:
http://170.94.15.100/scripts/broker.exe?_service=default&_program=arcode.main_welcome_live.sas.
6.
Healthcare Cost and Utilization Project, 2010. Available from: http://hcupnet.ahrq.gov/.
7.
Arkansas Health Professions Manpower Statistics, 2011. Arkansas Department of Health.
8.
Small Area Health Insurance Estimates, 2010. U.S. Census Bureau. Available from:
http://www.census.gov/did/www/sahie/.
9.
Shortage Designation: Health Professional Shortage Areas and Medically Underserved
Areas/Populations, 2011. Health Resources and Services Administration. Available from:
http://bhpr.hrsa.gov/shortage/index.html.
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