Risk Factors for Heart Disease Among Adults 18 Years and Older

County Level Study

High blood pressure

Derived from "yes" response to the following question:

"Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure (HBP)?"
(Females are not counted as having HBP when responding "yes" to having been told had HBP only when pregnant.)

Diabetes

Derived from "yes" response to the following question:

"Have you ever been told by a doctor that you have diabetes?"
(Females with pregnancy (gestational) diabetes and people with pre-diabetes or borderline diabetes are not included.)

Obesity

Derived by calculating BMI (body mass index) of 30 or greater using responses to the following questions:

"About how much do you weigh without shoes?"
"About how tall are you without shoes?"

Overweight

Derived by calculating BMI (body mass index) of 25 to 29.9 using responses to the following questions:

"About how much do you weigh without shoes?"
"About how tall are you without shoes?"

High cholesterol

Derived from "yes" responses from respondents age 18 and older to the following three questions:

"Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked?" AND
"Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?" AND
"Do you still have high blood cholesterol?"

Current smoking

Derived from "yes" response to the following question:

"Have you smoked at least 100 cigarettes in your entire life?"
AND from "everyday" or "some days" response to the following question:
"Do you now smoke cigarettes every day, some days, or not at all?"

Secondhand smoke in home

Derived from ">=1" response to the following question:

"Not including yourself, during the past seven days, how many days did anyone smoke cigarettes, cigars, or pipes anywhere inside your home?"

Secondhand smoke at work

Derived from "Yes" response to the following question:

"As far as you know, in the past seven days, has anyone smoked in your work area?"

Physical inactivity

Derived from "No" response to the following question:

"During the past month, other than your regular job, did you participate in any physical activities or exercise such as running, calisthenics, golf, gardening, or walking for exercise? "
(Physical inactivity is also called “no leisure-time physical activity”.)

Low fruit and vegetable intake

Adults who reported eating fruits and vegetables less than five times per day.
Derived by calculating number of fruits and vegetables eaten per day using the following questions:

“During the past month, how many times per day, week, or month did you drink 100% pure fruit juices?”
“During the past month, not counting juice, how many times per day, week, or month did you eat fruit? Count fresh, frozen, or canned fruit.”
“During the past month, how many times per day, week or month did you eat cooked or canned beans, such as refried, baked, black, garbanzo beans, beans in soup, soybeans, edamame, tofu, or lentils.Do NOT include long green beans.”
“During the past month, how many times per day, week, or month did you eat dark green vegetables, for example broccoli or dark leafy greens including romaine, chard, collard greens, or spinach?”
“During the past month, how many times per day, week, or month did you eat orange-colored vegetables such as sweet potatoes, pumpkin, winter squash, or carrots?
“Not counting what you just told me about, during the past month, about how many times per day, week, or month did you eat OTHER vegetables?”

BRFSS

Heavy drinking

Adult males having more than two drinks per day and adult females having more than one drink per day on each day of the past 30 days.

Heavy drinking among males

Adult males having more than two drinks per day on each day of the past 30 days.

Heavy drinking among females

Adult females having more than one drink per day on each day of the past 30 days.

Angina or coronary heart disease

Derived from "yes" response to the following question:

"Has a doctor, nurse, or other health professional ever told you that you had angina or coronary heart disease?"

Incorrect answer for signs and symptoms of heart attack

Respondents incorrectly answered one or more of the following questions or responded “don't know” or “not sure”:

“Do you think pain or discomfort in the jaw, neck, or back are symptoms of a heart attack?” (Correct answer is “yes”.)
“Do you think feeling weak, lightheaded, or faint are symptoms of a heart attack?” (Correct answer is “yes”.)
“Do you think chest pain or discomfort are symptoms of a heart attack?” (Correct answer is “yes”.)
“Do you think sudden trouble seeing in one or both eyes is a symptom of a heart attack?” (Correct answer is “no.”)
“Do you think pain or discomfort in the arms or shoulder are symptoms of a heart attack?” (Correct answer is “yes”.)
“Do you think shortness of breath is a symptom of a heart attack?” (Correct answer is “yes”.)

Heart attack (myocardial infarction) prevalence

Derived from "yes" response to the following question:

"Has a doctor, nurse, or other health professional ever told you that you had a heart attack, also called a myocardial infarction?"

Age 18-44
Age 45-54
Age 55-64
Age 65+

Annual household income less than $15,000
Annual household income $15,000-$49,999
Annual household income $50,000+

Educational attainment less than high school
Educational attainment high school/GED
Educational attainment post high school

Male
Female

White
Black/African-American

 

Mortality/PAS (Hospitalization and ER Indicators)

Mortality

Heart Disease

Resident deaths during the eleven-year period for which the underlying cause of death was given on the death certificate as heart disease.

"Heart disease" is one of the National Center for Health Statistics’ standard categories for ranking the leading causes of death. It is the leading cause of death in Missouri and the US. Two major categories of heart disease deaths are due acute myocardial infarction ("heart attack") and heart failure, both described below.  Other heart disease causes of death include rheumatic heart disease, hypertensive heart disease, pulmonary embolism, various valve disorders, cardiomyopathy, and atrial fibrillation.

International Classification of Diseases (ICD-10) codes: I00-I09.9, I11-I11.9, I13-I13.9, and
I20-I51.9.

Acute Myocardial Infarction (MI)

Resident deaths for which the underlying cause of death was given on the death certificate as acute myocardial infarction. These deaths are included among deaths due to "Heart disease." An acute myocardial infarction (AMI) is death of tissue in heart muscle due to an interruption in the blood supply. An AMI, or "heart attack," is usually caused by a blood clot obstructing a coronary artery.

International Classification of Diseases (ICD-10) codes:  I21 - I22.9.

Congestive Heart Failure 

Resident deaths during the eleven-year period for which the underlying cause of death was given on the death certificate as heart failure. These deaths are included among deaths due to "Heart disease."  Heart failure is the inability of the heart to supply sufficient blood flow to meet the needs of the body and lungs.  Generally, cardiac output is low and the body becomes congested with fluid. 
International Classification of Diseases (ICD-10) codes: I50 – I50.9

Hospitalizations and Emergency Room Discharges

Heart Disease

Resident hospitalizations and emergency room discharges with a principal diagnosis of heart disease. This includes acute myocardial infarction (heart attack), rheumatic heart disease, hypertensive heart disease, pulmonary embolism, various valve disorders, cardiomyopathy, atrial fibrillation, congestive heart failure, chest pain, tachycardia, heart palpitations, meningococcal carditis, cocksackie carditis, and problems with transplanted heart valves and cardiac devices (pacemaker, etc.).

International Classification of Diseases (ICD-9-CM) codes according to the Clinical Classifications Software (CCS) categories: V422 V433 3940 3941 3942 3949 3950 3951 3952 3959 3960 3961 3962 3963 3968 3969 3970 3971 3979 4240 4241 4242 4243 42490 42491 42499 7852 7853 03282 03640 03641 03642 03643 07420 07421 07422 07423 11281 11503 11504 11513 11514 11593 11594 1303 3910 3911 3912 3918 3919 3920 393 3980 39890 39899 4200 42090 42091 42099 4210 4211 4219 4220 42290 42291 42292 42293 42299 4230 4231 4232 4238 4239 4250 4251 4252 4253 4254 4255 4257 4258 4259 4290 4100 41000 41001 41002 4101 41010 41011 41012 4102 41020 41021 41022 4103 41030 41031 41032 4104 41040 41041 41042 4105 41050 41051 41052 4106 41060 41061 41062 4107 41070 41071 41072 4108 41080 41081 41082 4109 41090 41091 41092 V4581 V4582 4110 4111 4118 41181 41189 412 4130 4131 4139 4140 41400 41401 41403 41406 4148 4149 78650 78651 78659 4150 4151 41519 4160 4161 4168 4169 4170 4171 4178 4179 41410 41411 41412 41419 4291 4292 4293 4295 4296 42971 42979 42981 42982 42989 4299 V450 V4500 V4501 V4502 V4509 V533 V5331 V5332 V5339 4260 42610 42611 42612 42613 4262 4263 4264 42650 42651 42652 42653 42654 4266 4267 42681 42689 4269 4270 4271 4272 42731 42732 42760 42761 42769 42781 42789 4279 7850 7851 42741 42742 4275 39891 4280 4281 42820 42821 42822 42823 42830 42831 42832 42833 42840 42841 42842 42843 4289.

Congestive Heart Failure

Resident hospitalizations and emergency room discharges with a principal diagnosis of congestive heart failure. Congestive Heart Failure is defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body and lungs. This is most common where cardiac output is low and the body becomes congested with fluid.

International Classification of Diseases (ICD-9-CM) codes according to the Clinical Classifications Software (CCS) categories: 39891, 4280, 4281, 42820, 42821, 42822, 42823, 42830, 42831, 42832, 42833, 42840, 42841, 42842, 42843, 4289.

Acute Myocardial Infarction (MI)

Resident hospitalizations and emergency room discharges with a principal diagnosis of acute myocardial infarction. An acute myocardial infarction (AMI) is death of tissue in heart muscle due to an interruption in the blood supply. An AMI, or "heart attack," is usually caused by a blood clot obstructing a coronary artery.

International Classification of Diseases (ICD-9-CM) code: 410.

ST Elevation MI (STEMI)

Resident hospitalizations and emergency room discharges with a principal diagnosis indicating myocardial infarction with ST-segment elevation. A STEMI heart attack is one for which the electrocardiogram shows ST-segment elevation, usually in association with an acutely blocked coronary artery. A STEMI is one type of heart attack that is a potentially lethal condition for which specific therapies, administered rapidly, reduce mortality and disability. The more time that passes before blood flow is restored, the more damage that is done to the heart muscle.

International Classification of Diseases (ICD-9-CM) codes: 410.0-410.6, 410.8.

Non-ST Elevation MI (NSTEMI)

Resident hospitalizations and emergency room discharges with a principal diagnosis indicating myocardial infarction without ST-segment elevation. An NSTEMI is a type of heart attack caused by a partially blocked blood supply to a portion of the heart. While serious, this type of heart attack is not considered as dangerous as a STEMI heart attack, where an artery in the heart is completely blocking blood flow to a portion of the heart. This form of heart attack does not result in an elevation of the 'ST segment' of the electrocardiogram. 

International Classification of Diseases (ICD-9-CM) code: 410.7.

Hospitalization Utilization Indicators

Diseases of the Heart

Congestive Heart Failure

Total Charges

The amount that the hospital charges for inpatient hospitalization discharges for residents of the area (state, region, county) who were discharged with a diagnosis of heart disease or congestive heart failure. The charges do not necessarily represent the cost to the hospital of providing the care nor do they represent the amount actually collected by the hospital for providing the care.

Total Days of Care

The days of care (length of stay) in the hospital for residents of the area (state, region, county) who were discharged with a diagnosis of heart disease or congestive heart failure.

Myocardial Infarction

ST Elevation MI (STEMI)
Non-ST Elevation MI (NSTEMI)

Total Charges

The amount that the hospital charges for inpatient hospitalizations for residents of the area (state, region, county) discharged with a diagnosis of acute myocardial infarction with or without a ST-segment elevation. The charges do not necessarily represent the cost to the hospital of providing the care nor do they represent the amount actually collected by the hospital for providing the care.

Total Days of Care

The days of care (length of stay) in the hospital for residents of the area (state, region, county) discharged with a diagnosis of acute myocardial infarction with or without a ST-segment elevation.

Discharge Status

Home: Discharged to home or self-care—routine discharge.
Rehabilitation: Discharged to a rehabilitation facility. This is not coded by all hospitals and is probably underreported.
Other LTC Facility: Discharged to an intermediate care facility, skilled nursing facility, or long term care hospital.
Died: Patient died in the facility.