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High blood cholesterol (HBC) (i.e., total cholesterol ≥240 mg/dL) is a major risk factor for heart disease, the leading cause of death in the United States.[1] As a result, public health agencies and their partners have attempted to reduce the prevalence of HBC through screening and by increasing public awareness of HBC and strategies for reducing it. A national health objectives of Healthy People 2010 is to increase to 80% the proportion of adults aged ≥20 years who have been screened for HBC within the preceding 5 years.[2] For this report, data from the Behavioral Risk Factor Surveillance System (BRFSS) collected during 1991-2003 were analyzed to examine trends in the percentage of adults screened for HBC and the percentage of those screened who were told they had HBC. The findings indicated that both percentages increased during 1991-2003 but that few states had achieved the national health objective for screening. Further emphasis on cholesterol screening is needed, particularly among Hispanic and Asian/Pacific Islander populations and young adults.
BRFSS is a state-based, random-digit-dialed telephone surveillance system that samples the noninstitutionalized, U.S. civilian population aged ≥18 years. For this report, CDC analyzed BRFSS data from 1991, 1993, 1995, 1997, 1999, 2001, and 2003 for 1,027,793 persons aged ≥20 years. Response rates for BRFSS surveys ranged from 71.4% in 1993 to 51.1% in 2001.[3] Survey participants were asked whether they had ever had a blood cholesterol screening and, if so, how long it had been since their last screening. Those who reported having ever been screened were asked whether they had ever been told by a health-care professional that they had HBC. Data were weighted to account for age, race/ethnicity, and sex distributions of the population in each state. Statistical software was used to account for the complex sampling design. The results were age-standardized to the 2000 U.S. standard population.[4] Percentage change was calculated as the 2003 prevalence minus the 1991 prevalence divided by the 1991 prevalence multiplied by 100.
During 1991-2003, the prevalence of cholesterol screening during the preceding 5 years and the percentage of persons screened who were told they had HBC increased overall and among all age, sex, and racial/ethnic groups ( Table 1 ). The percentage of those screened within 5 years increased from 67.6% (95% confidence interval [CI] = 67.2-68.1) in 1991 to 73.1% (CI = 72.7-73.4) in 2003. Although the prevalence of cholesterol screening within 5 years was higher among women than men in all years represented, the percentage change in prevalence was smaller for women than men. In 2003, the prevalence of cholesterol screening was lowest among Hispanics (65.5%; CI = 64.1-67.0) and Asians/Pacific Islanders (69.6%; CI = 66.9-72.4). The largest percentage changes in prevalence of cholesterol screening were among American Indians/Alaska Natives and non-Hispanic blacks. The overall percentage of those screened who had been told they had HBC increased from 25.3% (CI = 24.7-25.8) in 1991 to 31.1% (CI = 30.7-31.5) in 2003. The percentage change among men told they had HBC was more than twice that among women. The percentage of those screened who were told they had HBC was higher in all racial/ethnic groups in 2003 than in 1991, with the greatest increase observed among Hispanics. Similarly, reporting of HBC increased among all age groups, with the largest percentage change in prevalence among those aged ≥65 years.
In 46 states and the District of Columbia (DC), the prevalence of screening increased from 1991 to 2003, with percentage change ranging from 0.3% in Iowa to 17.5% in Kentucky ( Table 2 ). However, by 2003, only DC and Massachusetts had achieved the Healthy People 2010 objective for cholesterol screening, with rates of 80.2% and 80.6%, respectively. The proportion of screened adults who had been told they had HBC increased in 44 states and DC, with increases ranging from 1.1% in Vermont to 47.5% in DC ( Table 3 ).
Reported by: AE Saddlemire, CH Denny, PhD, KJ Greenlund, PhD, JN Coolidge, MPH, AZ Fan, MD, PhD, JB Croft, PhD, Div for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC.
Morbidity and Mortality Weekly Report. 2005;54(35):865-870. © 2005 Centers for Disease Control and Prevention (CDC)
Cite this: Trends in Cholesterol Screening and Awareness of High Blood Cholesterol - United States, 1991-2003 - Medscape - Sep 09, 2005.
