Health & Welfare | Daily Report

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The rates of hospitalizations and deaths due to heart attacks are decreasing in California, but a state analysis released yesterday reveals troubling trends: Heart attacks are sending more racial and ethnic minorities to the hospital, and they're killing patients at a younger age.

Overall, the number of heart attacks per 1,000 Californians fell nearly 15 percent from 1988 to 2008, according to the Office of Statewide Health Planning and Development. But that decline was driven only by white patients, who represented 61 percent of all heart attack hospitalizations in 2008.

Among racial and ethnic minorities, heart attack hospitalizations jumped by as much as 62 percent. While whites saw a 12.5 percent drop in hospitalizations, the rate increased by 33 percent for African Americans, 33.6 percent for Hispanics, nearly 55 percent for Asian/Pacific Islanders and 62.3 percent for Native Americans.

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The increases reflect rising rates of risk factors, such as obesity and diabetes – conditions that have seen dramatic increases among minorities, said Mary Tran, an OSHPD research scientist and author of the state's analysis [PDF]. The percentage of patients hospitalized for heart attacks who also had diabetes nearly doubled over the two decades, from 19.9 percent to 38.1 percent.

Similarly, higher mortality rates among younger patients have come with increasing rates of hypertension. For heart attack patients younger than 40, deaths spiked 85.5 percent from 1988 to 2008. A nearly 13 percent decline in overall heart attack mortality was attributed to older patients; only patients age 60 and older saw declines in heart attack deaths over this period.

The findings, based on hospital inpatient data, suggest that "people are getting sick sooner or they're not thinking they're going to get heart attacks at those young ages," Tran said. "The risk is there, and the awareness isn't."

The prevalence of coronary artery disease and heart attack mortality has been falling nationwide in recent decades. The state's analysis said about half of the decline may be a result of improved methods for opening blood flow and new medications that lower blood pressure and cholesterol levels.

Another 40 percent of the drop is due to declines in heart attack risk behaviors – namely cigarette smoking. In California, the percentage of daily smokers fell from 13 percent in 1995 to 9 percent in 2008.

Office of Statewide Health Planning and DevelopmentPopulation rate of heart attack hospitalizations by race/ethnic group in California, 1988 to 2008. Click image to enlarge.

During the same time, the state's obesity rate grew from 15 percent to 24 percent. Obesity and diabetes, as a result, have offset about half the benefit of decreased smoking, the analysis said.

"People have stopped smoking and started eating," said Maribeth Shannon, director of the California HealthCare Foundation's market and policy monitor program.

But there is hope that obesity and diabetes rates will decrease as well, Shannon said. 

"There's increasing attention to this problem of obesity and diabetes and how it's affecting people's overall health," she said. "Hopefully, they'll give up bad food just as they did smoking."