Georgia epidemiology report, Vol. 14, no. 12 (Dec. 1998)

December 1998

volume 14 number 12

Division of Public Health

The Georgia Epidemiology Report is a publication of the Epidemiology Section of the Epidemiology and Prevention Branch, Division of Public Health, Georgia Department of Human Resources

http://www.ph.dhr.state.ga.us

Director

Summary of the 1998 Georgia State of the

Kathleen E. Toomey, M.D., M.P.H.

Heart Report

Epidemiology and Prevention Branch State Epidemiologist

Introduction

Acting Director Kathleen E. Toomey, M.D., M.P.H.
Epidemiology Section
Chief Paul A. Blake, M.D., M.P.H.
Public Health Advisor Mel Ralston
Notifiable Diseases
Jeffrey D. Berschling, M.P.H., Carol Hoban, M.S., M.P.H. Katherine Gibbs McCombs, M.P.H. Jane E. Koehler, D.V.M., M.P.H.
Laura Gilbert, M.P.H., Kathryn E. Arnold, M.D. Amanda Reichert, R.N., M.S.
Susan E. Lance-Parker, D.V.M., Ph.D.
Chronic Disease and Injury
Ken Powell, M.D., M.P.H.- Program Manager, Patricia M. Fox, M.P.H., Rana Bayakly, M.P.H., Mary P. Mathis, Ph.D., M.P.H., Alexander K. Rowe, M.D., M.P.H.
Linda M. Martin, M.S.
Tuberculosis
Rose Marie Sales, M.D., M.P.H.- Program Manager Naomi Bock, M.D., M.S., Beverly DeVoe, M.S.
HIV/AIDS/Sexually Transmitted Diseases
John F. Beltrami, M.D., M.P.H.&T.M.- Program Manager Andrew Margolis, M.P.H., Lyle McCormick, M.P.H. Ann Buckley, M.P.H., Amy Hephner, M.P.H.
Perinatal Epidemiology
James W. Buehler, M.D. - Program Manager Leslie E. Lipscomb, M.P.H., Cheryl Silberman, Ph.D.,M.P.H.
Hui Zhang, M.D., M.P.H. Mohamed Qayad, M.D., M.P.H.
Corliss Heath, M.P.H.
Preventive Medicine Residents
Mark E. Anderson, M.D., M.P.H. Anthony Fiore, M.D., M.P.H.
EIS Officers
Julia Samuelson, R.N., M.P.H. & Keoki Williams, M.D.
Graphics Dept.
Jimmy Clanton Jr. & Christopher Devoe
Georgia Epidemiology Report Editorial Board
Editorial Executive Committee
Andrew Margolis, M.P.H. - Editor Paul A. Blake, M.D., M.P.H.
Jane E. Koehler, D.V.M., M.P.H. Jeffrey D. Berschling, M.P.H.
Kathleen E. Toomey, M.D., M.P.H. Angela Alexander - Mailing List Christopher Devoe - Graphics

Cardiovascular disease (CVD) is the leading cause of death in Georgia, accounting for 23,366 deaths, or nearly 40 percent of all deaths in the state. Mortality rates from CVD have been declining in the past two decades, although a perceptible leveling off of these rates has occurred in the last five years. This observable new trend may be the result of changes in the prevalence of risk factors contributing to CVD, as well as an increase in the number of CVD survivors who have a particularly high risk of dying from these conditions. This article is a summary of the 1998 Georgia State of the Heart Report1 ; it presents a brief overview of CVD mortality rates in the past 2 decades and reports the prevalence of modifiable CVD risk factors in Georgia.
CVD Trends in Georgia
CVD mortality rates have declined in both Georgia and the U.S. over the past 17 years, but rates in Georgia have remained approximately 10% above the national average during this period (Figure 1). The decline is presumably due to improvements in medical care and healthier lifestyles. Although the Georgia CVD mortality rate continues to decline, the rate of decline is slowing. From 1980-1992, the CVD mortality rate declined by an average of 2.4% per year. However, from 1992-1996, the rate of decline had slowed to only 0.4% per year. The rate of decline in CVD deaths has slowed for all age groups; however, the change has been most striking among older Georgians. For 45-64 year olds, the CVD mortality rate declined by 3.7% per year for 1980-1992, but by only 1.5% per year for 1992-1996. In contrast, for those 85 and older, the rate declined by 1.1% per year for 1980-1992, but actually increased by 0.7% per year for 1992-1996.
CVD is not just a disease of old age. Although atherosclerosis may begin in the teenage years, the age at which it kills varies greatly, and death often occurs before old age. In 1996, one in five Georgians who died of CVD was younger than 65 years of age. CVD mortality rates also differ by gender and race. Men have higher rates than women, and AfricanAmericans have higher rates than Whites. This pattern is also seen in national CVD mortality rates.
Prevalence of CVD Risk Factors
The leveling off of CVD mortality rates may be caused by the changing pattern of risk factors for heart disease and stroke, such as smoking, hypertension, hyperlipidemia, obesity and physical inactivity. The prevalence of the following risk factors was estimated by a telephone survey of a representative sample of Georgians 18 years of age and older (Georgia Behavioral Risk Factor Surveillance System).
Physical Inactivity & Being Overweight. In this study, physical inactivity is defined as the lack of regular activity, or participation in activities for less than 20 minutes at least 3 times per week, and overweight is defined as being at or above 120% of ideal body weight. There has been a steady increase in the percentage of overweight Georgians; between 1984 and 1996, the percentage increased from 19 to 30 percent. Since the 1980s, about two-thirds of Georgians reported they were not physically active on a regular basis (Figure 2). Losing weight and being physically active can improve blood pressure and cholesterol levels and can decrease the chance of developing diabetes, another risk factor for heart disease.
Georgia Department of Human Resources Division of Public Health Epidemiology & Prevention Branch, Epidemiology Section Two Peachtree St., N.W., Atlanta, GA 30303 - 3186 Phone: (404) 657-2588 Fax: (404) 657-2586

Figure 2 Figure 1

Figure 1. Cardiovascular Disease Death Rates in Georgia and the United States,
1980-1996
Deaths per 100,000 people per year
600
500
Georgia
400
United States
300
200
100
0 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96
Year Source: Georgia Division of Public Health, US Census Bureau, and the National Cente r for Health Statistics.

Figure 2. Percent of Georgians Who are

Physically Inactive and Percent who are

Percent 80

Overweight, 1984-1996

Sedentary Lifestyle 60

40
Obesity 20

0 84 85 86 87 88 89 90 91 92 93 94 95 96 Year
Source: Georgia Division of Public He alth.

Current Smoking. Current smoking is defined as someone who has smoked at least 100 cigarettes in their lifetime and who smokes now. The percentage of Georgians who smoke regularly declined from 31% in 1984 to 19% in 1992 (Figure 3). Since then the rate has not changed. In 1996, 20% of Georgians reported they smoked cigarettes regularly. Lowering smoking rates is a fundamental public health priority. In addition to its well-known association with cancer, smoking is a major CVD risk factor. In fact, each year smoking causes more deaths from heart attacks than from cancer. The good news is that giving up smoking quickly reduces the chance of developing cardiovascular disease. Within five years, the chances of having a heart attack are 50% to 70% lower for former smokers, compared to current smokers. Beyond getting current smokers to quit, it is equally important to prevent people from starting to smoke. For example, people who begin smoking before their eighteenth birthday have more trouble quitting.
Hypertension. Uncontrolled high blood pressure (>140/90) is a leading risk factor for stroke, the third leading cause of death in Georgia. The percentage of Georgians who reported having been told they had high blood pressure has remained in the 19%-24% range since the 1980s, although the percentage of those who have been treated successfully is not known. Some people can control their blood pressure by losing weight and engaging in regular physical activity.

tion of Georgians who have already had a heart attack or stroke is growing. These CVD survivors are at particularly high risk for dying from CVD, and thus contribute to a growing number of CVD deaths.
The practical implications of these findings are clear. Because heart attacks and strokes result from a process of arterial blockage that begins at an early age, a greater effort should be made to reduce the prevalence of CVD risk factors among all Georgians. These risk factors are primarily behavioral: quitting smoking, changing diet, engaging in regular physical activity, controlling hypertension, and reducing blood cholesterol. Sustained behavioral changes are often difficult to makeeven for highly motivated individuals. Therefore, it is crucial to engage entire communities in a process to change societal norms of behavior. Community leaders and parents can act as role models; and local environments, such as schools and workplaces, can be changed to facilitate healthy behaviors.
Much of CVD in Georgia is preventable. If we focus our attention on realistic ways of reducing risk, we can renew the decline in CVD mortality rates that Georgia has experienced over most of the past two decades. Georgians can work together to reduce the number of individuals in our state with unhealthy CVD behaviors.

Technical Notes

Conclusions
Cardiovascular disease is defined by the International Classification The steady decline in CVD mortality rates over the past two decades of Diseases, Ninth Revision, codes 390-448. The source of the numis slowing. A particularly disturbing facet of this change is seen ber of deaths was Vital Records. The source of the population estiamong elderly Georgians for whom the rate is actually increasing. It mates was the US Bureau of the Census. Cardiovascular disease is not possible to explain conclusively the change in CVD mortality mortality rates were age-adjusted using the direct method; the US rates, but two factors are probably important contributing causes. 1990 population was used as the standard. The source of the CVD First, there is either a leveling off or an increase in the percentage of risk factors was the Georgia Behavioral Risk Factor Surveillance SysGeorgians with unhealthy behaviors that put them at risk for a heart tem (BRFSS). attack or stroke. Second, due to advances in medical care, the popula-
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Figure 3. Percent of Georgians Reporting Current Smoking, 1984-1996

Percent 35

30

25

20

15

10

5

0
% Smokers

84 85 86 87 88 89 90 91 92 93 94 95 96
31.2 29.6 27.7 25.9 25.9 23.7 24.3 21.9 19.4 23.9 22.8 20.5 20.3

Year

Source: Georgia Division of Public Health.

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A 1999 edition of the Georgia State of the Heart Report will be available in early 1999. This report and the 1998 Georgia State of the Heart Report are available from the Georgia Division of Public Health (404-657-2588) and from the American Heart Association, Southeast Affiliate (770-952-1316).

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References
1998 Georgia State of the Heart Report. Georgia Department of Human Resources, Division of Public Health, and The American Heart Association, Southeast Affiliate, 1998. Pub No. DPH97.71HW.
This article was contributed by Trish Fox, M.P.H., Alex Rowe, M.D., M.P.H., and Ken Powell, M.D., M.P.H.

Progress Toward Eliminating Haemophilus influenzae Type b Disease Among Infants and Children -- United States, 1987-1997
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The "Father" of Modern Epidemiology Dr. John Snow (1813-1858)
Dr. John Snow is renowned worldwide for leadership in two medical disciplines. He was the first physician to practice full-time as an anesthetist, and actually delivered several of Queen Victoria's babies using chloroform. He is also recognized for using modern epidemiologic methods to interrupt the 1854 cholera epidemic in London. Dr. Snow mapped deaths from cholera and showed that the majority occurred within 250 yards of a water pump located at the intersection of Cambridge and Broad Streets. Suspecting the Broad Street pump as the source of disease, Dr. Snow had the water pump handle removed, thus ending the epidemic.
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The Georgia Epidemiology Report Epidemiology and Prevention Branch Two Peachtree St., NW Atlanta, GA 30303-3186

December 1998

Volume 14 Number 12

Reported Cases of Selected Notifiable Diseases in Georgia Profile* for September 1998

Selected Notifiable Diseases Campylobacteriosis Chlamydia genital infection Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Other** Syphilis - Congenital Tuberculosis

Total Reported for September 1998
1998 64 2335 20 8 161 1875 3 72 0 0 0 4 0 2 0 265 77 9 9 47 41 0 40

Previous 3 Months Total

Ending in September

1996

1997

1998

260

283

242

3646

3513

5584

44

41

53

21

12

33

306

311

412

5264

4232

5558

6

7

11

126

220

187

33

92

1

0

0

5

0

5

1

22

24

16

4

0

0

8

6

9

0

0

0

523

504

823

345

299

323

57

39

17

134

98

41

351

261

158

252

299

165

3

6

2

170

156

144

Previous 12 Months Total

Ending in September

1996

1997

1998

844

694

806

12872

15412

21512

101

68

119

43

43

71

735

834

1178

21839

18479

19766

43

44

51

322

645

742

54

186

180

5

2

12

1

6

8

162

113

97

10

12

2

32

24

27

0

0

0

1542

1413

1709

823

1195

1430

227

168

114

542

412

225

1373

1201

818

1031

1316

822

44

26

11

756

731

608

* The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia.
** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis.

Report Period
Latest 12 Months: 12/97 to 11/98 Five Years Ago: 12/92 to 11/93 Cumulative: 7/81 to 11/98

Total Cases Reported *
1326 1900 19851

AIDS Profile Update

Percent Female

Risk Group Distribution (%)

MSM IDU MSM&IDU

HS Blood

Unknown

18.3

39.2

17.6

4.9

13.3

0.8

24.3

15.2

45.7

22.5

6.0

13.1

1.5

11.3

15.2

50.9

19.3

5.9

12.1

1.9

10.0

Race Distribution (%) White Black Other

24.5 72.8

2.7

33.7 64.5

1.8

38.4 59.5

2.1

MSM - Men having sex with men

IDU - Injection drug users

HS - Heterosexual

* Case totals are accumulated by date of report to the Epidemiology Section

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