O.C. Women Rank High in Cardiac Death
Women in Orange County--along with those in Los Angeles, San Bernardino and Ventura counties--have among the state’s highest cardiac death rate, according to the first nationwide study of heart disease in women by region, race and ethnicity.
African American and white women in the four counties fared the worst. But across every race and ethnic category, women in these counties outpaced the state average in deaths due to heart disease, the report found. Riverside County did slightly better, but still ranked among the bottom half of counties in the state.
The study was published this week by the Centers for Disease Control and Prevention in Atlanta and the University of West Virginia. The findings, which covered 1991-95, generally conform to previous data on heart disease, although none before had analyzed data separately for women.
The report gives added emphasis to what health experts have known for years: It is a misconception to think of heart disease as a man’s illness. Rather, it kills more women than men in California and the nation, and the failure by women and their doctors to realize this fact leads to poor prevention, screening and treatment.
“Most studies show that women are underdiagnosed,” said Diana Cassady, who studies cardiovascular disease for the state Department of Health Services. “Women will come . . . with symptoms, [but] physicians don’t think of heart disease as the problem.”
Leading Death Cause
Heart disease is the leading cause of death among California women, killing 34,174 in 1996 (the latest year for which statistics are available), according to the state Department of Health Services. That same year, 33,502 men died of the disease.
Experts say that access to medical care and good diet, opportunity for exercise, smoking habits and socioeconomic status all affect mortality rates. Prevention techniques must target lifestyle, increase access to health care and provide good diagnosis and treatment, several experts said.
“There are many components to this disease,” said the study’s chief author, Dr. Michele Casper, an epidemiologist at the CDC.
Besides offering a county-by-county analysis nationwide, the report also provided death rates for women over 35 years of age among whites, blacks, Asian and Pacific Islanders, Latinas and Native Americans. Blacks had the highest death rates from heart disease, both in California and the nation. It was the only group to fare worse in the state than in the nation.
In California, Native Americans had the lowest mortality rate. In the country as a whole, Asians and Pacific Islanders fared best.
The death rate for California women was 373 per 100,000, compared to a national rate of 401. For black women in California, the rate was 574; for whites, 372; for Latinas, 260; for Asian and Pacific Islanders, 221, and for native Americans, 161.
The highest death rates due to heart disease were generally found in urban areas, including New York City, Detroit, Chicago and New Orleans, but also in the rural South, especially the Mississippi Delta and Appalachia. Low rates of fatal heart disease were found in the Rocky Mountain states, the Northwest, and most of Wisconsin and North and South Dakota.
Southern California urban counties ranked poorly against the rest of California, but they fell near the national average otherwise, Casper said.
Some results puzzled experts. For instance, the counties of San Francisco, Santa Cruz, San Mateo, Marin and Sonoma--all in more populated parts of Northern California--were among a dozen counties with the lowest mortality rates in the state, well below every Southern California county, including San Diego and Santa Barbara.
“This means to me that people in Southern California have to redouble our efforts to prevent the preventable aspects of heart disease: follow a low-fat diet, exercise regularly, do not smoke, get our cholesterol checked and be sure, if we have diabetes or other medical problems, that we are getting treatment,” said Dr. Deborah Judelson, cardiologist and past president of the American Medical Women’s Assn.
Different Risk Factors
Social and economic conditions play a significant role in determining heart health, several experts said.
“Many in low-income areas don’t have access to parks and exercise; they can’t buy heart-healthy foods,” Cassady said. “There is a very high rate of uninsured individuals who aren’t getting the screening and treatment they need.”
Women in rural areas can be cut off from health care by distance, but that same lack of medical care or follow-up treatment in urban areas is more often the result of no insurance or access to medical facilities.
“We really don’t have data to address directly the question of why the high rates in metropolitan centers,” Casper said.
The report does not address cause, but it is well-known that different ethnic and racial groups have different risk factors for heart disease or manifest shared risk factors more powerfully, according to several experts.
A significant risk factor for black women is hypertension. For white women, it can be smoking, and for Latinas, it can be obesity and diabetes. But those factors are not exclusive to any group, said Dr. Nathan Wong, an epidemiologist and director of the heart disease prevention program at UC Irvine’s College of Medicine.
