title: Heat Maps of Hypertension, Diabetes Mellitus, and Smoking in the Continental United States.
abstract: Geographic variations in cardiovascular mortality are substantial, but descriptions of geographic variations in major cardiovascular risk factors have relied on data aggregated to counties. Herein, we provide the first description of geographic variation in the prevalence of hypertension, diabetes mellitus, and smoking within and across US counties.
  
  
  
  We conducted a cross-sectional analysis of baseline risk factor measurements and latitude/longitude of participant residence collected from 2003 to 2007 in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Of the 30 239 participants, all risk factor measurements and location data were available for 28 887 (96%). The mean (±SD) age of these participants was 64.8(±9.4) years; 41% were black; 55% were female; 59% were hypertensive; 22% were diabetic; and 15% were current smokers. In logistic regression models stratified by race, the median(range) predicted prevalence of the risk factors were as follows: for hypertension, 49% (45%-58%) among whites and 72% (68%-78%) among blacks; for diabetes mellitus, 14% (10%-20%) among whites and 31% (28%-41%) among blacks; and for current smoking, 12% (7%-16%) among whites and 18% (11%-22%) among blacks. Hypertension was most prevalent in the central Southeast among whites, but in the west Southeast among blacks. Diabetes mellitus was most prevalent in the west and central Southeast among whites but in south Florida among blacks. Current smoking was most prevalent in the west Southeast and Midwest among whites and in the north among blacks.
  
  
  
  Geographic disparities in prevalent hypertension, diabetes mellitus, and smoking exist within states and within counties in the continental United States, and the patterns differ by race.
authors.affiliation: From the Department of Epidemiology (M.S.L., E.B.L.) and Department of Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology & Biostatistics and Department of Statistics & Probability, Michigan State University, East Lansing (G.d.l.C.); Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL (M.Z.A.-H.); Division of General Internal Medicine, Weill Department of Medicine, Weill Cornell Medical College, New York, NY (M.M.S.); and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.). loop2@uab.edu.
authors.forename: Matthew Shane
authors.initials: MS
authors.lastname: Loop
authors.affiliation: From the Department of Epidemiology (M.S.L., E.B.L.) and Department of Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology & Biostatistics and Department of Statistics & Probability, Michigan State University, East Lansing (G.d.l.C.); Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL (M.Z.A.-H.); Division of General Internal Medicine, Weill Department of Medicine, Weill Cornell Medical College, New York, NY (M.M.S.); and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.).
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.affiliation: From the Department of Epidemiology (M.S.L., E.B.L.) and Department of Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology & Biostatistics and Department of Statistics & Probability, Michigan State University, East Lansing (G.d.l.C.); Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL (M.Z.A.-H.); Division of General Internal Medicine, Weill Department of Medicine, Weill Cornell Medical College, New York, NY (M.M.S.); and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.).
authors.forename: Gustavo
authors.initials: G
authors.lastname: de Los Campos
authors.affiliation: From the Department of Epidemiology (M.S.L., E.B.L.) and Department of Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology & Biostatistics and Department of Statistics & Probability, Michigan State University, East Lansing (G.d.l.C.); Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL (M.Z.A.-H.); Division of General Internal Medicine, Weill Department of Medicine, Weill Cornell Medical College, New York, NY (M.M.S.); and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.).
authors.forename: Mohammad Z
authors.initials: MZ
authors.lastname: Al-Hamdan
authors.affiliation: From the Department of Epidemiology (M.S.L., E.B.L.) and Department of Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology & Biostatistics and Department of Statistics & Probability, Michigan State University, East Lansing (G.d.l.C.); Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL (M.Z.A.-H.); Division of General Internal Medicine, Weill Department of Medicine, Weill Cornell Medical College, New York, NY (M.M.S.); and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.).
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: From the Department of Epidemiology (M.S.L., E.B.L.) and Department of Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology & Biostatistics and Department of Statistics & Probability, Michigan State University, East Lansing (G.d.l.C.); Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL (M.Z.A.-H.); Division of General Internal Medicine, Weill Department of Medicine, Weill Cornell Medical College, New York, NY (M.M.S.); and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.).
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.affiliation: From the Department of Epidemiology (M.S.L., E.B.L.) and Department of Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology & Biostatistics and Department of Statistics & Probability, Michigan State University, East Lansing (G.d.l.C.); Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL (M.Z.A.-H.); Division of General Internal Medicine, Weill Department of Medicine, Weill Cornell Medical College, New York, NY (M.M.S.); and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA (L.A.M.).
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
mesh_terms: D001741:Black or African American; D017677:Age Distribution; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology* / Q000208:ethnology; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People
keywords: cardiovascular diseases; diabetes mellitus; epidemiology; hypertension; risk factors