Awareness, Treatment and Control of Hypertension, Diabetes and Hyperlipidemia and Area-Level Mortality Regions in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Background. Health Professional Shortage Areas (HPSA) receive extra federal resources, but recent reports suggest that HPSA may not consistently identify areas of need. Purpose. To assess areas of need based on county-level ischemic heart disease (IHD) and stroke mortality regions. Methods. Need was defined by lack of awareness, treatment, or control of hypertension, diabetes, or hyperlipidemia. Counties were categorized into race-specific tertiles of IHD and stroke mortality using 1999-2006 CDC data. Multivariable logistic regression was used to model the relationships between IHD and stroke mortality region and each element of need. Results. Awareness and treatment of cardiovascular (CVD) risk factors were similar for residents in counties across IHD and stroke mortality tertiles, but control tended to be lower in counties with the highest mortality. Conclusions. High stroke and IHD mortality identify distinct regions from current HPSA designations, and may be an additional criterion for designating areas of need.