Clustering risk factors for cardiovascular disease in rural Pennsylvania population

Background: Cardiovascular disease is the leading cause of deaths in the United States. Poor lifestyles, such as physical inactivity, smoking, and poor diet, contribute to cardiovascular disease. Rural populations often have disadvantages to good health. In Pennsylvania, the rural population has increased in the past decade.

Purpose: To identify if rural Pennsylvanians experience more cardiovascular disease compared urban Pennsylvanians, and to evaluate risk factors for cardiovascular disease among rural Pennsylvanians.

Methods: Data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. BRFSS is an ongoing data collection program, monitoring risk behaviors for chronic diseases in the adult U.S. population. Cardiovascular disease, smoking, alcohol use, physical activity, and fruits/vegetables consumption were self-reported. Statistical program SUDAAN was used to analyze data, as SUDAAN can account for the complex survey design and sample weight.

Findings: A total of 13,378 Pennsylvania residents participated in the 2005 BRFSS, with 37.2% (n=5,879) resided in a rural area. Compared to urban residents, rural residents experienced a significantly higher prevalence rate of heart disease (5.9% vs. 4.6%) and heart attack (5.2% vs. 4.2%). Rural residents also had a significantly higher current smoking rate than urban residents (25.4% vs. 22.6%). There were significantly more rural residents than urban residents who consumed less than five servings of fruits/vegetables per day (80.0% vs. 73.8%). Moreover, rural residents showed a cluster of risk factors from poor lifestyles - having different risk factors together. After controlling for other aspects, being a rural resident was significantly linked to a 45% increased chance of cardiovascular disease (p-value=0.0004).

Conclusions: Health education on healthy lifestyles among rural populations is urgent. It is necessary to develop health promotion programs, which target rural residents, to help individuals change their unhealthful behaviors, and to enable them to increase control over and to improve their health.