Heart Smart Plan | Cancer Quick Facts
Heart Disease
Heart disease is a costly and deadly burden to the state of Ohio. In 2022, heart disease killed more than 30,000 Ohioans, and Ohio had the 12th highest rate of deaths from heart disease in the nation.
February is American Heart Month and new analysis from HPIO shows that early deaths from heart disease among working-age Ohioans (ages 15-64) vary greatly by county.
According to data included in HPIO’s October 2023 data snapshot Updated Death Trends among Working-age Ohioans, heart disease was the third-leading cause of death for working-age Ohioans, accounting for 5,654 deaths in 2022.
Using data from 2021 and 2022, HPIO found the age-adjusted rate of heart disease deaths among working-age Ohioans in each county, as illustrated above. The analysis shows wide geographic disparity in death rates. For example, Mercer County had the highest rate in Ohio, which, at 272.5 deaths per 100,000 population, was more than twice the rate of the lowest county, Noble, which experienced 132.6 deaths per 100,000 population.
According to the CDC, risk factors for heart disease include high blood pressure, high low-density lipoprotein (LDL) cholesterol, diabetes, smoking, overweight/obese, unhealthy diet and physical inactivity. Conditions in the communities in which we live, such as access to healthy food and healthcare services and the availability of high-quality jobs, can influence these risk factors.
Heart disease is the leading cause of death both in Ohio and the United States. Nationally, 1 out of every 4 deaths is due to heart disease. Heart disease includes several different diseases and conditions: coronary heart disease (CHD), myocardial infarction (MI or heart attack), and heart failure. CHD is the most common type of heart disease and is caused by a buildup of plaque along the walls of arteries, reducing blood flow to the heart. This reduction in blood flow can cause recurrent chest pain (angina) or, if severe, can deprive heart muscle of oxygen and cause an MI. Heart failure occurs when the heart muscle is too weak to pump blood well enough to supply the body with a sufficient amount of oxygenated blood.
In addition to being the leading cause of death, heart disease can lead to decreased quality of life, increased disability, and higher healthcare costs. Many people who have heart disease have other chronic conditions as well. Most adults have at least one risk factor for developing heart disease.
Burden
Heart disease is a costly and deadly burden to the state of Ohio. In 2022, heart disease killed more than 30,000 Ohioans, and Ohio had the 12th highest rate of deaths from heart disease in the nation. Ohio’s age-adjusted rate of deaths from heart disease (193.9 per 100,000) was 16% higher than the rate for the United States. Heart disease is a major health burden for all populations regardless of sex, race, ethnicity, age, and geography.
In 2022, 5.6% of adults in Ohio were living with coronary heart disease and 5.4% had suffered a heart attack. Men had a significantly higher prevalence of heart disease than women. The prevalence of heart disease is highest among older Ohioans and those with the lowest income and education. The prevalence of heart disease in 2022 did not differ significantly by race or ethnicity.
While the prevalence of heart disease did not differ by race, Black Ohioans had an 18% higher age-adjusted heart disease death rate in 2022, compared with White Ohioans. Men in Ohio were 61% more likely to die from heart disease than women. Black men had the highest rate of heart disease deaths (293.0 per 100,000) in Ohio in 2022. The heart disease death rate in Ohio varied greatly by county in 2022. The county with the highest crude death rate (Jefferson County) had a rate 2.8 times higher than the county with the lowest rate (Delaware County).
Risk Factors
Heart disease is caused by a complex set of risk factors that include genetics, environment, clinical risk factors (e.g., high blood pressure, high blood cholesterol), and behaviors.
Individuals are more likely to have heart disease if they:
- Have other chronic diseases, such as high blood pressure, high blood cholesterol, and diabetes.
- Have overweight or obesity.
- Use tobacco products.
- Drink too much alcohol, defined as more than one drink a day for women and more than two drinks a day for men.
- Eat a diet high in saturated fats, trans fats, cholesterol, and sodium (salt).
- Are not physically active.
Ohio adults who have ever smoked were more than two times as likely to have heart disease than those who never smoked, and obese adults were 1.6 times as likely to have heart disease compared to those with a healthy weight, according to 2022 data. Certain conditions put an individual at a much greater risk for developing heart disease. In 2021, 73.2% of adults in Ohio with heart disease also had hypertension and 66.4% also had high blood cholesterol. Adults in Ohio with heart disease were also more likely than those without heart disease to have asthma, diabetes, cancer, kidney disease, and chronic obstructive pulmonary disease.
Prevention and Management
Individuals can decrease their risk for developing heart disease by maintaining a healthy diet and an active lifestyle, not using tobacco products, and visiting their healthcare provider for annual checkups. For those who already have heart disease, healthy eating and provider-approved physical activity are key to managing heart disease.
It is estimated that one in three people with high blood pressure do not know that their blood pressure is elevated and are not receiving any kind of treatment. Many of those individuals have health insurance and see a healthcare provider regularly. When healthcare systems and providers use population health strategies such as utilizing their electronic health records to identify patients with undiagnosed hypertension, their risk of heart disease and stroke can be dramatically improved. In fact, population health strategies adopted by healthcare systems and providers such as team-based care and referrals to appropriate community resources can also improve management of patients with diagnosed chronic conditions.
After an individual is diagnosed with hypertension, high blood cholesterol, or another chronic condition, it is vital that the patient and providers act as a team to implement the best plan for the management of their condition. Often that plan includes medication to protect the body, but it is only effective if taken correctly. Inclusion of pharmacists as members of the healthcare team, especially in the provision of medication therapy management, can dramatically improve disease control rates and medication adherence. Clinical pharmacists can improve patient outcomes, reduce medical emergencies, prevent adverse drug events, and reinforce proper disease management messages when counseling patients.
In addition to care from the healthcare team, there are numerous community-based programs and resources that can support an individual’s management of their condition. There are resources for healthy eating and active living across the state in addition to community supports such as blood pressure cuff lending programs at libraries, churches, and barbershops. Self-management education classes and programs often do not require a referral by a healthcare provider. However, these classes/programs tend to have higher participation and retention rates and better health outcomes when people are referred by a healthcare provider.
Mercer County leads Ohio in the rate of early deaths from heart disease.
COLDWATER – Mercer County has the highest rate of early deaths from heart disease among working-age people in Ohio, a trend local public health officials aim to reverse through the next Community Health Improvement Plan.
While putting together the 2024 Community Health Needs Assessment, health officials were alerted to a Feb. 23 news release from the Health Policy Institute of Ohio stating that Mercer County leads the state in early deaths from heart disease among residents aged 15-64.
Mercer County’s rate is 272.5 deaths per 100,000 population, more than twice that of Noble County, which experienced 132.6 deaths per 100,000, according to the release.
“We’re proud of our No. 1 status in a lot of things, but that’s not one of them,” said Mindy Kremer, vice president of development, marketing and communications for Mercer Health, at last week’s hospital board of governors meeting.
Looking to tamp down that disquieting figure, health officials have made it their top priority to increase overall health and improve rates of chronic disease, specifically heart disease, in the 2025 CHIP to be released early next year.
Kremer said to accomplish that task, residents need to address factors leading to heart disease, such as high blood pressure, high cholesterol, smoking, alcohol and tobacco use, unhealthy diet and physical inactivity.
“For example, under the decreasing obesity rate, exploring increased access to weight management services is one idea,” she said. “Education to increase healthy food behaviors through digital communications is another.”
Kremer said seeing the same health diagnoses crop up every few years can be disheartening at times. However, she finds some comfort in Mercer County Health District Board of Health member Diane Lefeld’s assessment that change comes about incrementally when dealing with deeply ingrained behaviors.
“These are cultural norms that have been happening for decades that we’re trying to break down,” Kremer said. “We’re not going to change those things overnight.”
Ohio Department of Healthhttps://odh.ohio.gov › wps › wcm › connect › gov
[PDF] Geographic Disparities in Chronic Disease – Ohio Department of Health…
Community Health Needs Assessment
Mercer Health is a member of Community Organizations Linking Together (COLT) Health, a group of volunteers and employees of community organizations and agencies committed to improving the health of the people of Mercer County.
With support from Mercer County Health District and Mercer Health, the members of COLT Health act as the steering committee for the group’s mission, Live Well Mercer County.
COLT Health carries out a needs assessment and improvement plan.
A CHNA is an examination of the health status of a community used to identify areas of concern. It’s used to develop a Community Health Improvement Plan, or CHIP, consisting of benchmarks and goals focused on improving the overall health status of the community.
Mercer County’s last CHIP plan was for years 2022-2024. The 2025-2027 CHIP is being drafted and is expected to be released early next year.
A CHNA survey was administered via the online platform SurveyMonkey.
“We also had a Marshallese version and a Spanish version for those populations in our community,” Kremer said. “We also did focus groups with those two groups as well as the Amish community.”
Local physicians and nurses offered feedback, too, and additional information and data was gleaned from Foundations Behavioral Health Services in Celina and the Ohio Hospital Association, according to Kremer.
Mercer County has an adult population of roughly 31,000 people. Five hundred surveys were turned in, resulting in a 1.5% return rate, Kremer pointed out.
“You may say that’s horrible, but the benchmarks for these types of assessments is somewhere between 5-10%,” Kremer said. “So are we happy with ours? No. We know we have work to do in the future, but it’s gotten better every time we’ve done this.”
The results
The 2024 CHNA revealed 77% of respondents do not eat at least five servings of fruits and vegetables a day, a 1% improvement from the 2019 CHNA. Also, 50% indicated they eat fast food more than once a week, a 3% decline; 51% do not exercise at least three times a week, a 1% decline; 37% do not receive any annual wellness exam, a 5% improvement; and 43% do not receive recommended health screenings, a 13% improvement.
Moreover, 48% reported drinking alcohol at least weekly, a 19% improvement; 13% reported tobacco use, a 41% improvement; and 10% reported illegal drug use, a 14% increase. The assessment notes, though, that adult cannabis use became legal in Ohio in November 2023.
The top 10 most common diagnoses of hospitalized patients were, in first place, morbid obesity, followed by hypertension, COVID, type 2 diabetes, acute respiratory infection, hypothyroidism, hyperlipidemia/high cholesterol, obesity, urinary tract infection and atrial fibrillation.
The top 10 most common mental health diagnoses among residents seeking treatment were, in first place, depressive disorder, followed by anxiety disorder, adjustment disorder, post traumatic stress disorder, bipolar disorder, alcohol disorder, cannabis disorder, stimulant disorder, opioid disorder and schizophrenia.
Community Health Improvement Plan
Health officials are now putting the finishing touches on the 2025-2027 CHIP.
“We have a strategic planning meeting on Jan. 13,” Kremer said. “We really hammer through and create an in-depth plan: this is what we’re going to do … this is who is responsible.”
The 2022-2024 CHIP identified and prioritized mental and behavioral health, followed by healthy weight status, substance use and abuse and health care literacy and navigation.
A work plan expanded upon the health care priorities, including the No. 1 concern, mental and behavioral health.
“Like other rural counties, Mercer County has a per capita shortage of psychiatric care providers. Acute psychiatric care is located outside the county,” the plan states. “While there is still some stigma associated with seeking help with mental health problems in our community, there has been an increase in demand for mental health services. We will continue working to address stigma and access problems during the course of this CHIP.”
To learn more about Live Well Mercer County, the CHNA and the CHIP, visit www.livewellmercercounty.org.
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