Cardiovascular Disease in Tennessee Audrey M Bauer, DVM, MPH Surveillance, Epidemiology and Evaluation Tennessee Department of Health Practical Strategies

Cardiovascular Disease in Tennessee

Audrey M Bauer, DVM, MPH

Surveillance, Epidemiology and Evaluation Tennessee Department of Health

Practical Strategies in Medication Adherence for Cardiac and Stroke Patients – June 8, 2012

Overview

• Tennessee vs. the United States

• CVD risk factors

• CVD hospitalizations

• CVD mortality

Tennessee vs. The United States

• In 2009, Tennessee had the…– 8th highest heart disease mortality rate– 5th highest stroke mortality rate

Data source: Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final Data for 2007. National Vital Statistics Reports; vol. 58 no. 19. Hyattsville, MD: National Center for Health Statistics, 2010.

TN: 211/100,000US: 180/100,000


TN: 47/100,000US: 39/100,000


Tennessee vs. The United States

• In 2010, Tennessee had the…– 14th highest smoking prevalence– 7th highest obesity prevalence– 4th highest diabetes prevalence

Data source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Prevalence and Trends Data. Accessed November 2010 at http://apps.nccd.cdc.gov/brfss/.

Cardiovascular DiseaseRisk Factors

Risk Factor Prevalence (%) Change from 2000-2009

Diabetes 10.3 43%

Smoking 22.0 14%

High Blood Pressure 32.6 22%

High Cholesterol 32.9 20%

Physical Inactivity 64.0 no change

Overweight & Obesity 69.0 16%

CVD Risk Factor PrevalenceTennessee, 2009

Data source: Tennessee Department of Health; Office of Health Statistics; Behavioral Risk Factor Surveillance System (BRFSS). Data are for adults 18+ years of age.

36.5 35.4 36.8 35.4 37.034.9 36.5 36.7 36.8 36.1

22.9 23.4 24.5 25.027.2 27.4 28.8

30.7 31.232.9

0

10

20

30

40

50

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Per

cen

t

Year

Overweight and Obesity PrevalenceTennessee, 2000-2009 (BRFSS)

Overweight Obese


44% increase in obesity

None8.2%

One23.4%

Two32.0% Three to Six

36.4%

Number of CVD Risk Factors among AdultsTennessee, 2009 (BRFSS)


1.0 1.52.0 1.4

8.3

5.0

20.9

12.0

0

5

10

15

20

25

Heart Attack Stroke

Per

cen

tCVD Prevalence by Number of Risk Factors

Tennessee, 2009 (BRFSS)

0 1-2 3-4 5-6


Cardiovascular DiseaseHospitalizations

CVD Hospitalizations

• CVD are the leading cause of inpatient hospitalizations and the 3rd leading cause of emergency room visits in Tennessee

• In 2009, combined inpatient and outpatient hospital discharges for CVD totaled approximately 208,000

• Combined inpatient and outpatient hospital charges for CVD totaled over $5 billion in 2009 – a 79% increase since 2000

Data source: Tennessee Department of Health; Office of Health Statistics; Hospital Discharge Data System (HDDS).

Heart Disease Hospitalizations

• Heart disease is the most common cause of CVD hospital stays– 72% of inpatient hospitalizations– 62% of outpatient visits


1,528 1,545 1,545 1,549 1,5051,456 1,436

1,357 1,3231,242

798 804 840 840 860 830 800 775 800 839

0

200

400

600

800

1,000

1,200

1,400

1,600

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Ag

e-a

dju

ste

d R

ate

pe

r 1

00

,00

0

Year

Heart Disease In- and Outpatient HospitalizationsTennessee, 2000-2009

Inpatient Outpatient


2,3002,460

2,900

3,2903,510

3,6603,780 3,720

3,8504,040

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Tota

l Ch

arg

es (

$M)

Year

Total Hospital Charges for Heart DiseaseTennessee, 2000-2009 (HDDS)

Outpatient

Inpatient

Data source: Tennessee Department of Health; Office of Health Statistics; Hospital Discharge Data System (HDDS). Charges are inflation adjusted to 2009 dollars.

23

,20

0

25

,90

0 33

,40

0

29

,70

0 37

,20

0

36

,00

0

39

,30

0

40

,50

0

44

,10

0

43

,70

0

4,4

00

5,1

00

6,3

00

7,6

00

8,8

00

8,9

00

8,8

00

9,6

00

10

,00

0

11,7

00

0

10,000

20,000

30,000

40,000

50,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Ch

arg

es

Pe

r V

isit

($

)

Year

Per Visit Hospital Charges for Heart DiseaseTennessee, 2000-2009 (HDDS)

Inpatient

Outpatient

Data source: Tennessee Department of Health; Office of Health Statistics; Hospital Discharge Data System (HDDS). Charges are inflation adjusted to 2009 dollars.

1,410 1,405 1,429 1,465 1,414 1,375 1,3461,204 1,152

1,080

1,597 1,637

1,8271,930

1,7171,795 1,810

1,7071,612

1,530

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

2,200

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Ag

e-a

dju

ste

d R

ate

pe

r 1

00

,00

0

Year

Heart Disease Inpatient Hospitalizations by RaceTennessee, 2000-2009

White Black


861

1,395 1,352

1,705

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

White Female Black Female White Male Black Male

Ag

e-a

dju

ste

d R

ate

pe

r 1

00

,00

0Heart Disease Inpatient Hospitalizations by Gender & Race

Tennessee, 2009


Cardiovascular DiseaseMortality

0

100

200

300

400

500

600

700

800

900

1900 1920 1940 1960 1980 2000

Dea

ths

per

100

,000

Year

Age-Adjusted Mortality Rate for CVDUnited States, 1900-2007

Data source: CDC. Achievements in Public Health, 1900-1999: Decline in Deaths from Heart Disease and Stroke. MMWR 1999; 48(30):1141-1147.

449433

419431 433 427 418 418

405 396 395377 379

365339

328308

296 295278

0

100

200

300

400

500

600

Ag

e-a

dju

ste

d R

ate

pe

r 1

00

,00

0

Year

Cardiovascular Disease DeathsTennessee, 1990-2009

Data source: Tennessee Department of Health; Office of Health Statistics; Death Statistical System (DDS). Mortality rates prior to 1999 were compatibility adjusted to account for ICD revisions.

CVD Mortality

• In 2009, there were approximately 18,400 deaths due to CVD – about one death every 30 minutes

• Almost one-third of deaths in Tennessee are due to CVD– Heart disease is the 1st leading cause of death– Stroke is the 5th leading cause of death

Data source: Tennessee Department of Health; Office of Health Statistics; Death Statistical System (DDS).

Heart Disease24.4% (1)

Cancer23.2% (2)

CLRD6.0% (3)

Accidents5.4% (4)

Stroke5.4% (5)

Alzheimer’s3.8% (6)

Diabetes3.0% (7)

Flu and Pneumonia2.3% (8)

Kidney Disease1.6% (9)

Suicide1.6% (10)

All Other Causes23.1%

Leading Causes of DeathTennessee, 2009


392

344362 368

325 312 303284 277

257281 271 274 262

244 236 225 216 219 209

0

50

100

150

200

250

300

350

400

450

500

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Ag

e-a

dju

ste

d R

ate

pe

r 1

00

,00

0

Year

Heart Disease Deaths by RaceTennessee, 2000-2009

Black

White


161

206

276

338

0

50

100

150

200

250

300

350

400

White Female Black Female White Male Black Male

Age

-adj

uste

d Ra

te p

er 1

00,0

00Heart Disease Deaths by Gender and Race

Tennessee, 2009


Questions?

Audrey [email protected]

Health Information Tennessee (HIT) – http://hit.state.tn.us/

Documents

Cardiovascular Disease in Tennessee Audrey M Bauer, DVM, MPH Surveillance, Epidemiology and Evaluation Tennessee Department of Health Practical Strategies