CARDIOVASCULAR & CANCER RATES FOR THE RURAL DELTA REGION

This is an interactive tool that shows 13 health measures for people in Delta Region counties/parishes.  We show rates of cancer and cardiovascular diseases across the region, which have previously been shown to be 10-20% higher than peer counties and the rest of the U.S., respectively.^[1],[2] You can use this tool to compare rates by county, by rural-urban status, to peer counties, to the national average, to national quartiles, by the Health Resources and Services Administration (HRSA) regions, and by states. We’ve included features that allow users to

• Download images and data.
• Compare groups of rural and urban Delta counties.
• Visualize rates based on levels of incidence (darker colors equal greater incidence).
• Select which levels of incidence to feature on the map. For example, users can opt to show only counties with the highest incidence.
• Focus on any of the 12 HRSA-defined service regions in the Delta Region (e.g., Alabama Region A).
• Hover over each county to learn the county name, incidence, and HRSA service region.
• Click on a county and immediately be taken to a data spreadsheet with all the data.
• Filter to look at county data by state(s), rural/urban, Delta Region (yes/no).

In 2020, 234 Delta counties were economically distressed counties.⁴ Sadly, as poverty and poor health are often intertwined, the Delta Region also has a history of having poorer health outcomes compared to the rest of the nation.⁵ Decades ago, these communities faced higher rates of hunger and infectious disease, and now, obesity and diabetes have taken root.  Residents of the Delta Region have significantly higher rates of cardiovascular disease and cancer than the rest of the nation—particularly among rural and Black residents.^5,6

The Delta Region was originally designated by Congress in 1988 through the Lower Mississippi Delta Development Act⁷ to provide federal assistance to the poorest region in the country. In 2000, Congress established the Delta Regional Authority (DRA), which serves the region by coordinating and investing federal funding in the Delta counties.⁸ As most of the region is rural, the Federal Office of Rural Health Policy is one of the federal agencies investing in the health of the people of the Delta Region by enhancing health care delivery and addressing unmet health care needs and prevalent health disparities. Examples of HRSA grant programs in the Delta Region include the Delta Region Community Health Systems Development Project improves, the Delta States Rural Development Network Grant Program, and the Delta Region Rural Health Workforce Training Program.

Purpose of the webpage

To assist with these and other initiatives, we created an interactive, web-based mapping tool and provide data on rates of cancer and cardiovascular diseases⁹ across the Delta Region, which have previously been shown to be 10-20% higher than peer counties (non-Delta counites in a Delta state) and the rest of the U.S., respectively.^5,10 Users can access maps and data tables.  Health data specific to rural Delta Region is hard to find. The DRA provides one of the few resources of publicly available health data for the Delta Region. The DRA Today’s Delta¹¹ report includes obesity, diabetes, physical inactivity, and health insurance measures, but these data are limited to four health measures and do not provide rural and urban differences. With our website, users can access 13 health indicators, with county-level rates stratified by rural and urban. Users can compare disease rates among their counties to other Delta counties. Data for metro Delta counties are also available and can be included or excluded based on the user’s needs.

Race and Ethnicity – State Charts

The Delta Region has a history of slavery, racial segregation, discrimination.¹² This legacy and the population demographics make race a particularly salient issue in studying and addressing challenges in the region. Cardiovascular disease and cancer are leading causes of death for all races, but Black people are 30 percent more likely to die prematurely from cardiovascular disease than Whites, and Black men are twice as likely as White men to die of stroke.¹³ Most states in the Delta Region have higher proportions of Black residents than the U.S. average. Table 1 shows the Delta states populations by race in 2019 compared to the U.S average. County-level disease incidence and mortality rates by race are difficult to capture and report with public data due to small sample sizes and privacy issues (suppressed data).  While not as granular as we could like, we are able to present rural and urban race and ethnicity for many populations at the state-level.  The website includes a chart pack of age-adjusted mortality by race and ethnicity and rural status for eight health conditions from 2015 to 2019 in the U.S. Delta Region states. We analyzed data for the following conditions: bladder cancer, breast cancer, colorectal cancer, kidney cancer, lung cancer, skin cancer, prostate cancer, and major cardiovascular disease. The figures are stratified by race and ethnicity and rurality. We used the following race/ethnicity categories: Black or African American, White, Asian or Pacific Islander, American Indian or Alaska Native, Hispanic or Latino, and Not Hispanic or Latino. Metro included areas classified as Large Central Metro, Large Fringe Metro, Medium Metro, or Small Metro. Non-metro included areas classified as Micropolitan or Non-Core. Searches were conducted by stratifying each condition by state and race or ethnicity. Race (Black, White, Asian or Pacific Islander, and American Indian or Alaska Native) and ethnicity (Hispanic and Not Hispanic) were searched separately. Data representing ten or fewer people are suppressed. Data representing fewer than 20 people are marked as unreliable and thus not presented here. All data were retrieved from the Centers for Disease Control and Prevention (CDC) WONDER database.

Table 1. Population Estimates for Delta States with Race and Hispanic Origin, Percentages, July 1, 2019¹⁹

Reading the Map

In the map, darker blue colors denote higher rates based on national quartiles; thus, by assessing the overall color prevalence, the user can see how the distribution among Delta counties compares to the national distribution. Urban/metro counties are grey. Counties where data are suppressed are light green. Hover over counties to see individual county name, rate, and HRSA Delta Region. Click on a county to see the data table.

Impact of Small Populations

Population numbers for rural (nonmetro) Delta Region counties range from 1,327 (Issaquena County, Mississippi) to 82,124 (St. Landry Parish, Louisiana). Rates for counties with smaller populations are affected in two ways. First, the rate is automatically suppressed for any county with fewer than 10 cases in the period, and the rate is deemed “unstable” with fewer than 20.  We combined both these categories to create a single suppressed category. The impact of data suppression varies. Up to 37% of Delta counties had suppressed data for some conditions — bladder cancer (60 counties suppressed), breast cancer (4), Colon cancer (5), kidney cancer (43), lung cancer (1), skin cancer/melanoma (65), prostate cancer (6).

Second, and more fundamentally, counties with smaller populations (and thus smaller denominators) have more variability in their rates; a couple of cases can have a much larger impact on the rate for small counties than for large counties. Statistically, we expect lower-population counties to have the highest (and lowest) rates, so the maps should be interpreted with that in mind.

Data Sources

Cancer incidence rates. We used the age-adjusted incidence rates per 100,000 by cancer site for 2013-2017 using Centers for Disease Control and Prevention (CDC) U.S. Cancer Statistics. We selected eight sites based on those with the most complete data and highest incidence across the region. We include incidence rates for all-sites (combined cancer incidence), bladder cancer, breast cancer, colon cancer, kidney cancer, lung cancer, melanoma, and prostate cancer.

Cardiovascular-related incidence and prevalence rates. The diabetes and obesity prevalence rates for adults aged 20 and above are from the CDC (2017).^14,15 Diabetes incidence rates per 1,000 population are also included (2017).¹⁶ Cardiovascular disease and stroke hospitalization rates are per 1,000 Medicare Beneficiaries aged 65 and older, 2015-2017.¹⁷

State Mortality Rates: The state mortality rates are from the 2019 CDC Multiple Cause of Death File..¹⁸

Table 2. Definitions and Sources 

References and Notes

1. Map Room. Delta Regional Authority. Available at: https://dra.gov/about-dra/map-room/.
2. For ease of exposition, in this brief, the term “counties” includes other county-like units such as Louisiana’s
3. Core based statistical areas (CBSA). March 2020. Available at: https://www.census.gov/geographies/reference-files/time-series/ demo/metro-micro/delineation-files.html.
4. Distressed counties have: 1) an unemployment rate one percent or higher than the national rate for the most recent two-year period and 2) have a per capita income of 80 percent or less of the national per capita income. Distressed Counties and Parishes. FY Delta Regional Authority. Available at: https://dra.gov/funding-programs-states-economic-development/states-economic- development-assistance-program/distressed-counties-and-parishes/.
5. Cosby AG, Bowser DM. The Health of the Delta Region: A Story of Increasing Disparities. Journal of Health and Human Ser- vices Administration 2008;31(1):58-71. Available at: http://libproxy.lib.unc.edu/login?url=https://www-proquest- com.lib.unc.edu/docview/200010994?accountid=14244.
6. Excel Workbook Tables: Mortality Rates among Persons by Cause of Death, Age, Region, and Rural-Urban Status: United States, 2011-2013. Exploring Rural and Urban Mortality Differences. NORC at the University of Chicago. Available at: https://norc.org/Research/Projects/Pages/exploring-rural-and-urban-mortality-differences.aspx.
7. R.5283 – Lower Mississippi Delta Development Act. 100th Congress (1987-1988). Available at: https://www.congress.gov/ bill/100th-congress/house-bill/5283.
8. 7 USC Chapter 50, Subchapter VI: Delta Regional Authority. Available at: https://uscode.house.gov/view.xhtml?path=/ prelim@title7/chapter50/subchapter6&edition=prelim.
9. Cancers: All cancer, bladder, breast, colon, lung, melanoma, prostate, kidney; CVD, Diabetes Prevalence, diabetes incidence, obesity prevalence,
10. Felix H, Stewart MK. Health Status in the Mississippi River Delta Region. South Med J 2005;98(2):149–54. Available at: https://org/southern-medical-journal/article/health-status-in-the-mississippi-river-delta-region/.
11. Today’s Delta: A Research Tool for the Region. Second edition, February 2015. Available at: https://dra.gov/images/uploads/ content_files/Todays_Delta_FINAL_print-w-borders.pdf.
12. Hardt BL, Logan TD, Parman J. 2018 September. “The Historical Role of Race and Policy for Regional Inequality.” In Place-Based Policies for Shared Economic Growth, edited by Jay Shambaugh and Ryan Nunn, 43-70: Washington, DC: The Hamilton Project. Available at: https://www.hamiltonproject.org/assets/files/ES_THP_PBP_book_20190425.pdf.
13. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Ne- gussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. 2, The State of Health Disparities in the United States. Available from: https://www.ncbi.nlm.nih.gov/ books/NBK425844/.
14. Diagnosed U.S. Diabetes Surveillance System. Center for Disease Control and Prevention. 2017. Available at: https:// gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html.
15. U.S. Diabetes Surveillance System. Center for Disease Control and Prevention. 2017. Available at: https://gis.cdc.gov/ grasp/diabetes/DiabetesAtlas.html.
16. Newly Diagnosed U.S. Diabetes Surveillance System. Center for Disease Control and Prevention. 2017. Available at: https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html#.
17. Hospitalization Rate per 1000 Medicare Beneficiaries 65plus, 2014-2016, CDC website https://nccd.cdc.gov/DHDSPAtlas.
18. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2019 on CDC WONDER Online Database, released in 2020. Data are from the Multiple Cause of Death Files, 1999-2019, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at https://wonder.cdc.gov.html on May 28, 2021.
19. Quick Facts, U.S. Census. Available at: https://www.census.gov/quickfacts/fact/table/US/PST045219.