Determinants of mortalities and morbidities of cardiovascular diseases in United States: A geographic analysis

Recently, the “obesity paradox” has being raising the great concerns in public health professionals because it indicates that overweight is a protective factor for cardiac or no cardiac mortality. The objective of this geographic analysis is to determine the risk factors of coronary artery disease (CAD) as well as cerebella vascular disease (CVD) in different states of United States. Multiple linear regression models were conducted to assess the association between the cardiovascular disease related risk or protective factors (independent variables) and mortalities or morbidities of cardiovascular diseases (dependent variables). Data were driven from CDC Wonder and Risk Behavior Surveillance System (2003 and 2005). After screening 36 independent variables by correlation coefficients, the significant independent variables were selected to entry into stepwise multiple linear regression model. The results indicate that overweight is significantly associated only with decreased CVD morbidity (beta = -0.111), but is not a significantly protective factor for other conditions. Obesity is significantly associated with increased CVD mortality (beta = 1.602) and this positive association did not show statistical significance with other conditions. Other significant risk factors, such as increased cholesterol level, hypertension, diabetes, smoking everyday, African American, no regular exercise, and no health care coverage were also identified in this study. In order to evaluate these models, estimated values were compared to the observed values and the mean of absolute percentage errors are between 10 to 12%. The results indicated that overweight may not be associated with increased cardiovascular disease mortality and morbidity.