U.S. counties with higher percentages of smokers and violent crime and lower rates of high school graduates are associated with higher mortality rates from cardiovascular disease, according to new public health findings from UT Southwestern Medical Center cardiologists and data scientists.

The preliminary findings, presented at the American Heart Association (AHA) Epidemiology, Prevention, Lifestyle & Cardiometabolic Health conference, offer a first-of-its-kind, county-by-county glimpse of heart disease across the nation over more than three decades.

“For clinicians, it’s very natural to focus on the modifiable risk factors for our patients. That’s not wrong, however, it’s important to understand that some of an individual’s risk factors are not necessarily under their control. And some factors may be modifiable through public policy and health systems changes and programs,” said senior author Dr. Ambarish Pandey, Assistant Professor of Internal Medicine at UT Southwestern, Texas Health Resources Clinical Scholar, and an Associate Program Director for UTSW’s Internal Medicine Residency. “While it’s important to educate our patients on addressing those risk factors they can control, these results point to the need to address public health at the community, state, and national level.”

Geographically, counties with the highest mortality were more concentrated in the Deep South and portions of Appalachia and the South Atlantic states, while the lowest mortality rates were more concentrated in the Northwest, Midwest, Great Plains, and parts of the Northeast and Florida.

Counties with high mortality were more concentrated in areas known to have high mortality rates and multiple chronic health conditions such as heart disease, stroke, high blood pressure, Type 2 diabetes, and obesity.

“Factors such as education level and violent crime rates aren’t typically considered as modifiable risk factors for cardiovascular disease by public health agencies. Yet, we found that they both influenced long-term health outcomes even when we adjusted for traditional cardiovascular health risk factors such as smoking rates, access to physical activities, and obesity. And we found that the social and health risk factors aligned significantly,” said lead author Dr. Shreya Rao, a cardiology research fellow at UT Southwestern who was a finalist for the Jeremiah and Rose Stamler Research Award for New Investigators at the AHA conference. “Our study findings highlight the need to target both social and health behavior-based risk factors for reducing the existing disparities in CV health across counties.”

UT Southwestern ranks 13th in the nation for cardiology and heart surgery by U.S. News & World Report. Find out more about cardiovascular research at UT Southwestern Clinical Heart and Vascular Center.

Researchers examined National Center for Health Statistics mortality data from 1980 to 2014 from all 3,133 counties in the United States, then compared the data with county-level characteristics such as demographics, socioeconomics, health status, crime rates, housing vacancies, number of businesses, and food deserts.

Co-authors are Dr. Amy E. Hughes, Assistant Professor in the Department of Population and Data Sciences; Dr. Colby Ayers, Faculty Associate of Internal Medicine; Dr. Matthew Segar, resident; Dr. Sandeep Das, Associate Professor of Internal Medicine and member of the  Young Clinicians and Investigators Committee of the AHA Quality of Care and Outcomes Research Council; Dr. Ethan A. Halm, Professor of Internal Medicine and Population and Data Sciences, and Chief of the Division of General Internal Medicine. The research was supported by research grants from the Texas Health Resources Scholarship and the National Institute on Aging.