Spatial and temporal patterns of cardiovascular disease in the United States and England: A comparison of data from national health surveillance databases

Date of Completion

January 2008


Geography|Health Sciences, Public Health|Health Sciences, Epidemiology




Cardiovascular disease has been identified as a major public health problem in the United States and England. National health surveillance data are collected in both countries to monitor the health of their populations. The purpose of this dissertation is to investigate geographical and temporal patterns of cardiovascular disease risk factors, symptoms, and diagnoses by comparing data drawn from the National Health Nutrition Examination Survey (NHANES) and the Behavioral Risk Factor Surveillance System (BRFSS) in the United States and the Health Survey for England (HSE) in England for 1998–2000 and 2003–2004. ^ Five hypotheses are tested to investigate patterns of cardiovascular disease among adults 40 years and older by race/ethnicity using data from the three surveillance databases. Methods used to test the hypotheses include calculating prevalence and confidence intervals, testing for differences in proportions, calculating odds ratios and confidence intervals, and logistic regression modeling. The logistic regression models test the effects of different survey methods and regional variables on the probability of cardiovascular disease diagnosis given individual demographic characteristics and risk factors. ^ Analyses of all three databases confirm that people are more likely to be diagnosed with cardiovascular disease if they are also diagnosed with hypertension and high cholesterol levels. The proportion of people living with hypertension and high cholesterol levels increased for nearly all racial/ethnic groups from the first time period to the second. In the U.S., older males with lower socioeconomic status, hypertension, and high cholesterol living in southern states have an increased probability of cardiovascular disease diagnoses. In England, regional variables were not as important in explaining cardiovascular disease diagnoses. ^ This research underscores the importance and challenges of international comparative studies on health outcomes and risk factors. Although it is difficult to obtain consistent data from national surveillance databases in different time periods and places, the surveillance databases show consistent patterns at the national level despite differences in the socioeconomic characteristics of the survey populations. Differences between the U.S. and England in the importance of regional variables is evidence of the need for geographically disaggregate data on health. ^