By Sandy Alexander
WASHINGTON – Women on the Lower Shore and in far Western Maryland are more likely to die of heart disease than women in central and urban counties, according to a report released last week.
Health officials in the state said two major factors may account for the disparity — a lack of access to health care in rural areas and increased risk factors, such as poor diet and lack of exercise. Both could be aggravated by the relatively high poverty in those regions, they said.
“Education and income seem to matter,” said John Ryan, director of the chronic disease program for the Maryland Department of Health and Mental Hygiene.
People with more education and higher income levels tend to smoke less and get treatment for hypertension sooner, he said. Access to health insurance may play a role as well.
The report by West Virginia University and the federal Centers for Disease Control and Prevention studied average annual mortality rates due to heart disease for women over 35 in all 50 states and the District of Columbia. The study covered deaths from 1991 to 1995.
It included statistics on death from heart disease caused by blocked arteries, usually involving heart attacks, as well as heart disease associated with high blood pressure. It did not include deaths from stroke.
Maryland’s rate of 395 deaths per 100,000 women over 35 was below the national average of 401 deaths per 100,000. Still, Maryland was in the lower half of the states overall, ranking 28th among all states and the District.
As in the rest of the nation, the report said black women in Maryland had higher rates of heart disease death than any other racial or ethnic group in the state.
Fourteen Maryland counties had rates higher than the national average, with the top six clustered in the western and southeastern corners of the state.
“There are two major factors” affecting heart disease rates in Maryland, said Frederick Kuhn, director of preventive cardiology at Mid-Atlantic Cardiovascular in Baltimore. “One is a difference in risk factors. The second is probably simply access issues.”
State and county officials believe poverty may increase the presence of risk factors for heart disease: The Maryland counties with the highest heart disease mortality rates also had the greatest percentage of families living below the poverty level, according to Census Bureau data.
Residents of rural counties face particular lifestyle and doctor-access issues, experts said.
Garrett County has very long winters and limited exercise facilities, said Amy Ritchie, a registered dietician for the county health department. There is not a YMCA or an indoor mall for people to walk around in, leading to a lot of overweight people at risk for heart problems, she said.
Ritchie estimated that residents need to travel 30 to 40 miles on average to see a doctor, and said there are no cardiologists in the county.
Heart disease is “a real problem for our entire area” said Wicomico County Health Officer Judith Sensenbrenner, who believes residents do not understand the need for prevention.
In addition to problems with poverty and lack of health insurance, lack of public transportation makes it difficult for family members to see their doctors before problems develop, Sensenbrenner said.
Douglas Wilson, director of planning and business development at Peninsula Regional Medical Center in Salisbury, said the Lower Shore has “a great deal of heart disease associated with risky behaviors” such as smoking, obesity, unhealthy diet and a sedentary lifestyle.
Peninsula said it has the largest cardiac rehabilitation program in the state and performs over 500 open-heart surgeries a year, but is surrounded by counties with high mortality rates for women with heart disease.
Many counties have community awareness, physical fitness, stop smoking and nutrition programs in schools and community venues. Peninsula even has a van that travels around the area offering blood pressure screenings. But Wilson acknowledged that it is very difficult to get people to seek care in the region.
“We try to find them, we try to get them in,” Wilson said. But, many people “tend not to go until it’s too late.”
Wilson warned that the numbers might be misleading because it is difficult to develop statistics with such small populations. But authors of the CDC/West Virginia University report said they factored in death rates for surrounding counties in an effort to counteract the limited sample.
Heart disease is the No. 1 cause of death in Maryland for both men and women, killing nearly 12,000 people each year, according to state health department statistics.
The risk factors for heart disease are the same for women and men, said Kuhn, who acts as a consultant to the Maryland chapter of the American Heart Association.
But, women are less likely to have classic symptoms of heart disease, such as pressure and tightness in the chest, he said. Doctors who are not sensitized may not realize neck and arm pains or shortness of breath may be signs of heart problems in women.
