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Prevalence of Cholesterol Screening and High Blood Cholesterol Among Adults — United States, 2005, 2007, and 2009

High blood cholesterol is a leading risk factor in the development of atherosclerosis and coronary heart disease (CHD) (1,2). The risks associated with high blood cholesterol can be reduced by screening and early intervention (3). Current clinical practice guidelines provide evidenced-based standards for detection, treatment, and control of high blood cholesterol (4). Healthy People 2020 monitors national progress related to screening and controlling high blood cholesterol through the National Health Interview Survey and the National Health and Nutrition Examination Survey (NHANES). State-level estimates of self-reported cholesterol screening and high blood cholesterol prevalence are available using Behavioral Risk Factor Surveillance System (BRFSS) data. To assess recent trends in the percentage of adults aged ≥18 years who had been screened for high blood cholesterol during the preceding 5 years, and the percentage among those who had been screened within the previous 5 years and who were ever told they had high blood cholesterol, CDC analyzed BRFSS data from 2005, 2007, and 2009. The results of that analysis showed that the percentage of adults reporting having been screened for high blood cholesterol within the preceding 5 years increased overall from 72.7% in 2005 to 76.0% in 2009. In addition, the percentage who had ever been told they had high cholesterol increased from 33.2% to 35.0%. Both self-reported screening and high cholesterol varied by state and sociodemographic subgroup. To reach the Healthy People 2020 target for cholesterol screening, public health practitioners should emphasize the importance of screening, especially among younger adults, men, Hispanics, and persons with lower levels of education.

BRFSS is a state-based, random-digit–dialed telephone survey conducted annually since 1984 with assistance from CDC. The survey is conducted among noninstitutionalized, U.S. adult civilians aged ≥18 years. Cholesterol questions have been asked in odd-numbered years. In 2005, 2007, and 2009, three questions were asked: "Have you ever had your blood cholesterol checked?" "About how long has it been since you last had your blood cholesterol checked?" and "Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?" Median response rates were 51.1%, 50.6%, and 52.5% in 2005, 2007, and 2009, respectively.

The percentages of respondents who reported being screened for cholesterol during the preceding 5 years were calculated, and general comparisons were made with the target for Healthy People 2020 objective HDS-6.* Because measured blood cholesterol is not available in BRFSS, direct comparison of results could not be made with two other Healthy People 2020 objectives that are based on measured results from NHANES (HDS-7, reduce the proportion of adults with high total blood cholesterol levels of >240 mg/dL; and HDS-8, reduce the mean total blood cholesterol levels among adults). However, self-reported health-care provider diagnosis of high blood cholesterol has been used previously to monitor prevalence of high blood cholesterol nationally and at the state level (5). Therefore, this report provides an update of the percentage of respondents who were ever told they had high blood cholesterol among those who had been screened within the preceding 5 years.

Data were analyzed by age group (18–44, 45–64, and ≥65 years), sex, race/ethnicity (white, black, Hispanic, Asian/Pacific Islander, and American Indian/Alaskan Native), and education (less than high school diploma, high school diploma, some college, college degree or higher). All reported percentages were age-standardized using the 2000 U.S. standard projected population, distribution no. 8 (6), except for age groups, for which age-specific percentages were reported. Linear trends across survey periods were assessed using orthogonal polynomial coefficients, and results with a p-value <0.05 were considered significant. The total number of respondents ranged from 356,112 in 2005 to 432,607 in 2009. State-specific (including the District of Columbia [DC]) sample sizes ranged from 2,432 (Alaska, 2009) to 39,549 (Florida, 2007).

From 2005 to 2009, the overall percentage of adults screened for high blood cholesterol during the preceding 5 years increased from 72.7% to 76.0% (Table 1). Increases in the percentage of persons screened for high blood cholesterol were observed across all age, sex, racial/ethnic, and education categories. The percentage of respondents screened for high blood cholesterol in 2009 was significantly higher among persons aged 45–64 years (88.8%) and ≥65 years (94.7%) than 18–44 years (63.2%); women (77.6%) compared with men (74.5%); blacks (77.6%), whites (77.3%), and Asian/Pacific Islanders (77.2%) compared with Hispanics (69.2%); and those with some college (77.5%) and a college degree or higher (83.0%) compared with those with a high school diploma (71.0%) and less than a high school diploma (61.4%).

By state, in 2009, the percentage of respondents screened for high blood cholesterol ranged from 67.7% in Idaho to 84.5% in DC. From 2005 to 2009, the percentage increased significantly in most states; two states (Missouri and South Carolina) showed a decreased percentage of respondents screened, but neither difference was statistically significant. Sixteen states showed no significant change in the percentage screened. In general, prevalence of cholesterol screening was higher among residents of eastern states than western states (Figure).

Among respondents who had been screened for high blood cholesterol within the previous 5 years, the percentage who reported being told by a health-care provider that their blood cholesterol was high increased from 33.2% in 2005 to 35.0% in 2009 (Table 2). Increases were observed across all age, sex, and education categories and among whites, blacks, and Hispanics. The prevalence of high blood cholesterol was significantly higher among persons aged ≥65 years (54.4%) than 18–44 years (23.7%) and 45–64 years (46.1%); men (37.5%) compared with women (32.6%); Hispanics (36.3%) and Asian/Pacific Islanders (37.5%) compared with blacks (33.1%); and those with less than a high school diploma (39.9%) compared with those with some college (35.2%) and a college degree or higher (33.2%).

By state, in 2009, the prevalence of self-reported high blood cholesterol ranged from 30.5% in New Mexico to 38.8% in Texas. From 2005 to 2009, approximately one third of states showed a significant increase. Certain states showed decreased prevalence, but none of the decreases were statistically significant (Table 2, Figure).

Reported by

Jing Fang, MD, Carma Ayala, PhD, Fleetwood Loustalot, PhD, Shifan Dai, MD, Div for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC. Corresponding contributor: Jing Fang, jfang@cdc.gov, 770-488-5142.

Editorial Note

The results presented in this report show that during 2005–2009, the national and state-specific age-standardized percentages of adult respondents who had been screened for cholesterol during the preceding 5 years increased significantly. Also, the percentage of respondents who had been screened and who were ever told that they had high blood cholesterol increased overall and in many states. Differences in the prevalence of self-reported screening in the preceding 5 years and prevalences of self-reported high blood cholesterol were found among states and sociodemographic subgroups.

In 2005, using BRFSS data, CDC reported trends in cholesterol screening and prevalence of high blood cholesterol among adults, with a significant increase in both measures from 1991 to 2003 (5). Similar to those findings, this report shows that from 2005 to 2009 the prevalence of respondents screened and the prevalence of self-reported high blood cholesterol increased. These results indicate that screening for high blood cholesterol was lowest among those aged 18–44 years, Hispanics, and those with lower levels of education.

The finding of increasing self-reported high blood cholesterol might be attributable to increasing awareness of the health risks posed by high blood cholesterol or increasing prevalence of high blood cholesterol among adults ever screened, or both. A recent report using nationally representative data revealed that from 1999–2000 to 2009–2010, the prevalence of high total serum cholesterol (≥240 mg/dL) among the U.S. population aged ≥20 years with measured serum cholesterol levels declined from 18.3% to 13.4% (7). This suggests that the increasing prevalence of self-reported high blood cholesterol was more likely a result of improved awareness of the risks of high blood cholesterol than an actual increase in the prevalence of high blood cholesterol.

The findings in this report are subject to at least three limitations. First, BRFSS includes only the noninstitutionalized U.S. population and, during 2005–2009, did not include households with no telephone or only cellular telephones. Second, BRFSS data are self-reported. Because no measurement of blood cholesterol is taken with BRFSS, self-reported high blood cholesterol cannot be substantiated, and treatment and control cannot be assessed. Third, median response rates were <55% in all 3 years. However, despite these limitations, BRFSS is a large, population-based survey that provides the only state-level assessment of high blood cholesterol screening and prevalence every 2 years.

Early detection of high blood cholesterol through screening is the first important step to treatment and reducing the risk for heart attack and stroke (4). To reach high blood cholesterol screening targets, public health practitioners, health-care providers, and educators should emphasize cholesterol screening, especially for young adults, men, Hispanics, and those with lower levels of education.

A wide variety of community and medical treatment activities address cholesterol screening and treatment. For example, CDC's National Heart Disease and Stroke Prevention programs support states implementing evidence-based practices in community and clinical settings, specifically highlighting cholesterol control within communities (8). Therapeutic lifestyle changes are an important approach that incorporates a low-fat, high-fiber diet and physical activity on most days (9). If cholesterol-lowering drugs are needed, they are used together with therapeutic lifestyle changes. The National Cholesterol Education Program provides evidenced-based resources and recommendations to health-care providers, and new guidelines for cholesterol are currently being developed (4). Healthy People 2020 objectives aim to increase awareness of current cholesterol recommendations and provide targets for stakeholders. The Million Hearts initiative, a federal/private partnership, is a recent, innovative alignment and coordination of clinical and community activities targeting leading causes of cardiovascular disease morbidity and mortality, including high blood cholesterol (10). These and other community and clinical activities are important measures to combat the deleterious effects of high blood cholesterol.

References

  1. Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003;290:898–904.
  2. Achenbach S, Moselewski F, Ropers D, et al. Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography: a segment-based comparison with intravascular ultrasound. Circulation 2004;9:14–7.
  3. Pignone MP, Phillips CJ, Lannon CM, et al. Screening for lipid disorders: systematic evidence reviews, no. 4. Rockville, MD: Agency for Healthcare Research and Quality; 2001. Available at http://www.ncbi.nlm.nih.gov/books/nbk42635. Accessed August 31, 2012.
  4. Grundy SM, Cleeman JI, Merz C, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation 2004;110:227–39.
  5. CDC. Trends in cholesterol screening and awareness of high blood cholesterol—United States, 1991–2003. MMWR 2005;54:865–70.
  6. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People 2010 Stat Notes 2001;(20):1–10.
  7. Carroll MD, Kit BK, Lacher DA. Total and high-density lipoprotein cholesterol in adults: National Health and Nutrition Examination Survey, 2009–2010. NCHS data brief no 92. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2012. Available at http://www.cdc.gov/nchs/data/databriefs/db92.htm. Accessed August 31, 2012.
  8. CDC. CDC National Heart Disease and Stroke Prevention Program. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/dhdsp/programs/nhdsp_program/goals.htm. Accessed August 31, 2012.
  9. National Heart, Lung, and Blood Institute. Your guide to lowering your cholesterol with TLC: therapeutic lifestyle changes. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute; 2005. http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf. Accessed August 31, 2012.
  10. CDC. Million Hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors—United States. MMWR 2011;60:1248–51.

* Available at http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=21.

Persons identified as Hispanic might be of any race. Persons identified as white, black, Asian/Pacific Islander, or American Indian/Alaska Native are all non-Hispanic. The five racial/ethnic categories are mutually exclusive.


What is already known on this topic?

Cholesterol is a major risk factor for cardiovascular disease. In 2003, the percentage of adults who had their cholesterol screened during the preceding 5 years was 73.1%. Among those who had a cholesterol screening, 31.1% reported ever being told they had high cholesterol. The prevalence of cholesterol screening has been reported as higher among the elderly, women, whites, and blacks.

What is added by this report?

Behavioral Risk Factor Surveillance System data indicate that cholesterol screening increased from 72.7% in 2005 to 76.0% in 2009, whereas the percentage of those screened who reported being told they had high cholesterol increased from 33.2% to 35.0%. Previously identified demographic disparities persist.

What are the implications for public health practice?

Nationally, the percentage of adults screened for high cholesterol during the preceding 5 years remains lower than the Healthy People 2020 target of 82.1%, and the percentage of those tested reporting being told they had high cholesterol has increased. The overall and state-specific findings in this report can be used to assess current national and state trends and target resources toward at-risk populations.


TABLE 1. Age-specific and age-adjusted* percentage of adults aged ≥18 years who had been screened for high blood cholesterol during the preceding 5 years by sex, race/ethnicity, and state of residence — Behavioral Risk Factor Surveillance System, United States, 2005, 2007, and 2009

Characteristic

2005

2007

2009

% change from 2005 to 2009

p-value for linear trend

%

(95% CI)

%

(95% CI)

%

(95% CI)

Total

72.7

(72.4–73.1)

74.7

(74.4–75.1)

76.0

(75.7–76.3)

4.5

<0.001

Age group (yrs)

18–44

58.6

(58.1–59.1)

62.1

(61.5–62.7)

63.2

(62.6–63.8)

7.8

<0.001

45–64

86.2

(85.8–86.6)

87.7

(87.4–88.0)

88.8

(88.5–89.1)

3.0

<0.001

≥65

92.8

(92.4–93.2)

93.8

(93.5–94.1)

94.7

(94.5–95.9)

2.0

<0.001

Sex

Men

71.0

(70.5–71.5)

73.1

(72.6–73.6)

74.5

(74.0–74.9)

4.9

<0.001

Women

74.6

(74.2–74.9)

76.4

(76.0–76.8)

77.6

(77.2–78.0)

4.0

<0.001

Race/Ethnicity§

White

74.7

(74.4–75.0)

76.5

(76.1–76.8)

77.3

(77.0–77.7)

3.5

<0.001

Black

75.5

(74.6–76.5)

76.8

(75.7–77.8)

77.6

(76.6–78.7)

2.8

0.004

Hispanic

62.3

(61.2–63.5)

65.1

(64.0–66.2)

69.2

(68.2–70.1)

11.1

<0.001

Asian/Pacific Islander

72.2

(69.8–74.5)

76.5

(74.1–78.8)

77.2

(75.3–79.1)

6.9

0.001

American Indian/Alaska Native

68.4

(65.5–71.1)

74.0

(71.1–76.8)

73.6

(70.9–76.1)

7.6

0.007

Education

Less than high school diploma

57.1

(56.0–58.3)

58.5

(57.3–59.7)

61.4

(60.3–62.5)

7.5

<0.001

High school diploma

68.9

(68.3–69.5)

70.6

(70.0–71.2)

71.0

(70.4–71.6)

3.0

<0.001

Some college

75.1

(74.6–75.7)

76.8

(76.2–77.4)

77.5

(77.0–78.1)

3.2

<0.001

College degree or higher

80.1

(79.5–80.7)

81.8

(81.1–82.4)

83.0

(82.3–83.5)

3.6

<0.001

State

Alabama

72.0

(69.8–74.0)

75.8

(74.1–77.5)

75.8

(73.9–77.6)

5.3

0.007

Alaska

68.3

(65.7–70.7)

71.7

(69.0–74.3)

71.4

(68.5–74.1)

4.6

0.099

Arizona

66.1

(63.5–68.7)

70.7

(67.6–73.6)

72.3

(69.7–74.6)

9.2

<0.001

Arkansas

66.6

(65.0–68.1)

68.9

(67.3–70.6)

71.6

(69.0–74.1)

7.6

<0.001

California

72.3

(70.9–73.8)

75.0

(73.4–76.5)

74.7

(73.7–75.7)

3.3

0.008

Colorado

71.2

(69.9–72.5)

73.6

(72.5–74.7)

75.2

(73.8–76.4)

5.5

<0.001

Connecticut

78.0

(76.2–79.8)

79.7

(78.1–81.2)

80.4

(78.6–82.2)

3.1

0.062

Delaware

77.9

(76.0–79.6)

79.4

(77.1–81.5)

80.2

(78.1–82.2)

3.0

0.089

District of Columbia

79.7

(77.8–81.5)

83.9

(82.0–85.8)

84.5

(82.3–86.4)

6.0

<0.001

Florida

74.3

(72.7–75.8)

75.6

(74.3–76.8)

78.8

(76.9–80.6)

6.1

<0.001

Georgia

75.3

(73.6–76.9)

78.9

(77.2–80.4)

77.0

(74.9–79.1)

2.3

0.193

Hawaii

71.6

(70.1–73.1)

72.9

(71.3–74.4)

75.0

(73.3–76.6)

4.7

0.003

Idaho

66.2

(64.6–67.7)

66.0

(64.2–67.7)

67.7

(65.7–69.6)

2.3

0.242

Illinois

71.1

(69.5–72.7)

73.3

(71.6–75.0)

75.0

(73.4–76.7)

5.5

<0.001

Indiana

70.7

(69.3–72.1)

72.5

(70.9–74.2)

74.3

(72.8–75.8)

5.1

<0.001

Iowa

70.6

(69.0–72.2)

70.7

(69.1–72.3)

73.5

(71.8–75.1)

4.0

0.017

Kansas

69.6

(67.4–70.8)

71.4

(70.0–72.7)

73.7

(72.7–74.6)

5.8

<0.001

Kentucky

73.1

(71.5–74.7)

73.6

(71.5–75.5)

75.7

(73.8–77.6)

3.5

0.043


TABLE 1. (Continued) Age-specific and age-adjusted* percentage of adults aged ≥18 years who had been screened for high blood cholesterol during the preceding 5 years by sex, race/ethnicity, and state of residence — Behavioral Risk Factor Surveillance System, United States, 2005, 2007, and 2009

Characteristic

2005

2007

2009

% change from 2005 to 2009

p value for linear trend

%

(95% CI)

%

(95% CI)

%

(95% CI)

Louisiana

73.8

(71.7–75.7)

73.0

(71.5–74.5)

75.4

(73.8–76.9)

2.3

0.191

Maine

76.7

(74.9–78.5)

79.2

(77.7–80.7)

79.7

(78.1–81.2)

3.9

0.013

Maryland

78.6

(77.3–79.9)

79.2

(77.7–80.6)

82.0

(80.4–83.4)

4.2

<0.001

Massachusetts

78.2

(76.8–79.4)

82.2

(81.2–83.2)

82.4

(81.1–83.7)

5.5

<0.001

Michigan

75.1

(74.1–76.1)

77.4

(75.9–78.7)

78.7

(77.3–80.0)

4.7

<0.001

Minnesota

74.9

(72.8–76.8)

75.8

(74.1–77.5)

76.1

(74.3–77.8)

1.6

0.374

Mississippi

69.8

(68.0–71.5)

72.5

(71.0–74.0)

73.1

(71.6–74.5)

4.7

0.005

Missouri

72.0

(70.1–73.8)

72.4

(70.5–74.2)

71.0

(68.8–73.1)

-1.3

0.504

Montana

66.6

(64.8–68.4)

69.0

(67.3–70.8)

69.0

(67.2–70.8)

3.6

0.066

Nebraska

70.2

(68.7–71.6)

72.0

(70.0–73.9)

71.4

(69.6–73.2)

1.8

0.274

Nevada

66.0

(63.5–68.5)

69.8

(67.5–71.9)

73.1

(70.4–75.6)

10.6

<0.001

New Hampshire

79.0

(77.5–80.4)

77.9

(76.3–79.4)

80.2

(78.3–80.2)

1.5

0.327

New Jersey

76.2

(75.1–77.3)

78.4

(76.6–80.1)

80.9

(79.4–82.3)

6.1

<0.001

New Mexico

66.4

(64.8–68.0)

68.1

(66.4–69.7)

70.8

(69.2–72.4)

6.7

<0.001

New York

76.7

(75.3–78.0)

78.5

(76.9–80.1)

80.8

(79.2–82.4)

5.4

<0.001

North Carolina

71.4

(70.5–72.4)

77.0

(75.8–78.2)

76.9

(75.3–78.4)

7.7

<0.001

North Dakota

70.9

(69.2–72.5)

71.4

(69.7–73.2)

74.9

(73.1–76.7)

5.7

0.001

Ohio

71.8

(70.1–73.5)

72.2

(70.8–73.4)

75.0

(73.4–76.6)

4.4

0.008

Oklahoma

70.3

(68.8–71.7)

69.2

(67.8–70.7)

72.2

(70.6–73.8)

2.8

0.068

Oregon

67.0

(66.0–68.1)

69.0

(67.2–70.8)

71.7

(69.4–73.8)

6.9

<0.001

Pennsylvania

73.2

(72.0–74.4)

75.0

(73.5–76.5)

76.4

(74.9–77.9)

4.4

0.001

Rhode Island

79.7

(77.9–81.4)

79.6

(77.7–81.5)

82.5

(80.8–84.2)

3.6

0.021

South Carolina

77.9

(76.7–79.0)

77.3

(75.9–78.7)

76.5

(74.8–78.2)

-1.7

0.212

South Dakota

69.9

(68.4–71.3)

71.8

(70.1–73.4)

72.0

(70.1–73.8)

3.1

0.075

Tennessee

75.4

(73.3–77.3)

77.0

(74.8–79.1)

78.6

(76.4–80.7)

4.3

0.029

Texas

66.9

(65.4–68.3)

70.0

(68.9–71.2)

71.3

(69.7–72.9)

6.6

<0.001

Utah

66.1

(64.6–67.6)

68.7

(67.0–70.3)

70.0

(68.7–71.2)

5.8

<0.001

Vermont

74.4

(73.0–75.7)

74.3

(72.8–75.7)

75.2

(73.5–76.8)

1.1

0.428

Virginia

77.4

(75.7–79.0)

77.9

(76.0–79.7)

79.8

(77.7–81.8)

3.2

0.067

Washington

70.7

(69.9–71.5)

72.2

(71.4–73.0)

71.3

(70.3–72.3)

0.9

0.336

West Virginia

74.1

(72.2–75.9)

75.2

(73.4–76.9)

77.6

(75.8–79.3)

4.7

0.008

Wisconsin

71.7

(70.1–73.3)

75.7

(73.9–77.3)

75.6

(73.4–77.8)

5.5

0.005

Wyoming

72.9

(71.3–74.3)

71.9

(70.4–73.4)

73.8

(72.0–75.5)

1.3

0.423

Abbreviation: CI = confidence interval.

* Age-adjusted to the 2000 U.S. standard population; weighted estimates.

Not age-adjusted.

§ Persons identified as Hispanic might be of any race. Persons identified as white, black, Asian/Pacific Islander, or American Indian/Alaska Native are all non-Hispanic. The five racial/ethnic categories are mutually exclusive.


TABLE 2. Age-specific and age-adjusted* percentage of adults aged ≥18 years who had ever been screened for cholesterol and were told by a health-care provider that they had high blood cholesterol, by sex, race/ethnicity, and state of residence — Behavioral Risk Factor Surveillance System, United States, 2005, 2007, and 2009

Characteristic

2005

2007

2009

% change from 2005 to 2009

p-value for linear trend

%

(95% CI)

%

(95% CI)

%

(95% CI)

Total

33.2

(32.8–33.6)

34.3

(33.9–34.6)

35.0

(34.6–35.4)

5.4

<0.001

Age group (yrs)

18–44

21.8

(21.2–22.3)

22.9

(22.3–23.5)

23.7

(23.1–24.3)

8.7

<0.001

45–64

44.7

(44.1–45.3)

45.8

(45.3–46.3)

46.1

(45.7–46.5)

3.1

<0.001

≥65

52.0

(51.3–52.7)

53.9

(53.3–54.5)

54.4

(53.9–54.9)

4.6

<0.001

Sex

Men

34.9

(34.4–35.5)

36.9

(36.2–37.5)

37.5

(37.0–38.1)

7.4

<0.001

Women

31.5

(31.1–32.0)

31.8

(31.4–32.3)

32.6

(32.1–33.0)

3.5

0.001

Race/Ethnicity§

White

33.3

(33.0–33.7)

34.5

(34.1–34.9)

34.8

(34.4–35.2)

4.5

<0.001

Black

30.7

(29.5–31.9)

32.0

(30.9–33.0)

33.1

(32.0–34.3)

7.8

0.004

Hispanic

34.0

(32.5–35.6)

34.6

(33.2–36.1)

36.3

(35.1–37.5)

6.8

0.020

Asian/Pacific Islander

34.7

(31.8–37.8)

33.0

(29.7–36.5)

37.5

(35.0–40.0)

8.1

0.172

American Indian/Alaska Native

31.1

(27.6–34.7)

34.0

(31.1–36.9)

34.0

(31.2–37.0)

9.3

0.202

Education

Less than high school diploma

37.5

(35.8–39.2)

38.6

(37.0–40.2)

39.9

(38.5–41.3)

6.4

0.035

High school diploma

34.4

(33.7–35.2)

36.1

(35.4–36.9)

36.8

(36.1–37.5)

7.0

<0.001

Some college

33.3

(32.6–33.9)

34.1

(33.4–34.8)

35.2

(34.5–35.8)

5.7

<0.001

College degree or higher

31.8

(31.1–32.5)

32.7

(31.9–33.5)

33.2

(32.5–33.9)

4.4

0.005

State

Alabama

35.0

(32.6–37.5)

35.7

(33.8–37.7)

35.0

(32.9–37.1)

-0.1

0.989

Alaska

30.6

(27.9–33.4)

35.0

(31.5–38.7)

32.9

(29.8–36.2)

7.5

0.286

Arizona

30.1

(27.6–32.7)

36.7

(32.8–40.8)

36.8

(33.4–40.3)

22.2

0.002

Arkansas

33.1

(31.4–34.9)

35.3

(33.5–37.1)

33.2

(31.0–35.5)

0.4

0.930

California

33.3

(31.5–35.1)

32.6

(30.7–34.5)

34.2

(33.1–35.4)

2.8

0.385

Colorado

31.5

(29.9–33.2)

31.6

(30.4–32.7)

33.9

(32.3–35.6)

7.6

0.043

Connecticut

31.5

(29.5–33.5)

35.2

(33.2–37.2)

35.0

(32.7–37.3)

11.1

0.024

Delaware

35.7

(33.5–37.9)

34.5

(32.5–36.6)

33.8

(31.8–35.9)

-5.3

0.213

District of Columbia

31.3

(29.2–33.6)

34.7

(32.4–37.1)

33.7

(31.7–35.8)

7.5

0.121

Florida

35.4

(33.7–37.2)

33.5

(31.9–35.0)

34.2

(32.5–36.1)

-3.3

0.357

Georgia

30.5

(28.7–32.3)

36.2

(34.5–38.0)

35.2

(32.9–37.5)

15.3

0.002

Hawaii

31.9

(29.9–33.9)

31.8

(29.9–33.6)

35.9

(33.8–38.1)

12.6

0.008

Idaho

32.7

(31.0–34.5)

33.7

(31.9–35.6)

33.4

(31.4–35.4)

1.9

0.643

Illinois

33.7

(31.9–35.6)

33.0

(31.2–34.9)

35.0

(33.1–36.9)

3.7

0.367

Indiana

34.9

(33.2–36.6)

34.3

(32.5–36.2)

36.5

(34.8–38.2)

4.6

0.186

Iowa

32.4

(30.6–34.3)

32.7

(31.0–34.5)

33.6

(31.7–35.5)

3.8

0.371

Kansas

30.8

(29.4–32.2)

33.4

(31.8–35.1)

35.2

(34.0–36.3)

14.1

<0.001


TABLE 2. (Continued) Age-specific and age-adjusted* percentage of adults aged ≥18 years who had ever been screened for cholesterol and were told by a health-care provider that they had high blood cholesterol, by sex, race/ethnicity, and state of residence — Behavioral Risk Factor Surveillance System, United States, 2005, 2007, and 2009

Characteristic

2005

2007

2009

% change from 2005 to 2009

p-value for linear trend

%

(95% CI)

%

(95% CI)

%

(95% CI)

Kentucky

35.2

(33.4–37.1)

35.0

(33.1–37.0)

37.9

(35.9–39.9)

7.6

0.056

Louisiana

27.8

(25.8–30.0)

31.6

(29.7–33.6)

33.1

(31.6–34.7)

19.1

<0.001

Maine

32.9

(31.0–34.9)

36.8

(34.9–38.8)

34.0

(32.6–35.4)

3.2

0.382

Maryland

31.7

(30.2–33.2)

34.8

(33.1–36.5)

35.7

(33.9–37.5)

12.6

<0.001

Massachusetts

33.5

(31.8–35.3)

33.2

(32.1–34.2)

33.3

(31.8–34.9)

-0.6

0.864

Michigan

35.8

(34.6–37.0)

36.5

(34.9–38.2)

34.7

(33.3–36.2)

-2.9

0.274

Minnesota

30.7

(28.5–33.0)

29.4

(27.7–31.2)

32.0

(29.6–34.5)

4.3

0.430

Mississippi

34.6

(32.6–36.5)

34.7

(33.1–36.4)

36.8

(35.4–38.3)

6.5

0.070

Missouri

35.5

(33.1–38.0)

36.1

(33.6–38.7)

33.2

(31.2–35.3)

-6.4

0.167

Montana

30.6

(28.5–32.7)

30.5

(28.6–32.5)

32.3

(30.2–34.4)

5.5

0.270

Nebraska

32.2

(30.5–33.9)

32.9

(30.9–34.9)

32.7

(31.2–34.4)

1.8

0.626

Nevada

34.9

(32.2–37.8)

34.1

(31.7–36.6)

35.2

(32.3–38.2)

0.8

0.889

New Hampshire

32.7

(31.1–34.3)

35.4

(33.4–37.5)

35.7

(33.5–38.0)

9.4

0.031

New Jersey

34.1

(32.9–35.3)

36.2

(34.1–38.2)

34.4

(32.9–35.9)

0.9

0.763

New Mexico

27.3

(25.6–29.1)

30.6

(28.9–32.2)

30.5

(39.0–32.1)

11.8

0.008

New York

33.2

(31.6–34.8)

35.2

(33.4–37.1)

36.1

(34.3–37.9)

8.7

0.019

North Carolina

33.2

(32.1–34.3)

36.5

(35.1–38.0)

36.3

(34.7–37.9)

9.2

0.002

North Dakota

31.4

(29.5–33.5)

32.4

(30.5–34.3)

31.2

(29.4–33.0)

-0.8

0.847

Ohio

32.7

(30.9–34.6)

35.5

(34.0–37.0)

36.4

(34.5–38.3)

11.2

0.007

Oklahoma

34.3

(32.7–35.9)

36.0

(34.4–37.6)

35.6

(34.0–37.2)

3.8

0.259

Oregon

32.5

(31.3–33.8)

33.4

(31.6–35.3)

31.8

(29.4–34.3)

-2.2

0.610

Pennsylvania

33.6

(32.0–35.2)

35.1

(33.5–36.7)

35.0

(33.3–36.7)

4.4

0.224

Rhode Island

31.7

(29.9–33.5)

34.9

(32.9–37.0)

33.1

(31.4–34.9)

4.6

0.249

South Carolina

34.4

(33.0–35.8)

35.4

(34.0–36.8)

38.4

(36.2–40.6)

11.6

0.003

South Dakota

30.4

(28.9–32.0)

30.8

(29.0–32.7)

31.8

(29.8–34.0)

4.7

0.283

Tennessee

30.5

(28.6–32.5)

32.1

(29.5–34.8)

30.6

(28.3–32.9)

0.3

0.954

Texas

32.0

(30.4–33.6)

36.0

(34.7–37.3)

38.8

(36.7–40.9)

21.2

<0.001

Utah

32.2

(30.4–34.1)

32.3

(30.5–34.3)

32.7

(31.4–34.2)

1.7

0.636

Vermont

31.8

(30.3–33.5)

32.4

(30.1–34.8)

31.9

(30.2–33.6)

0.1

0.979

Virginia

34.7

(32.8–36.5)

34.2

(32.1–36.3)

35.0

(32.5–37.6)

1.0

0.820

Washington

33.8

(32.8–34.7)

33.8

(32.8–34.7)

34.8

(33.7–35.9)

3.1

0.162

West Virginia

35.5

(33.5–37.5)

37.2

(35.2–39.2)

34.6

(32.6–36.5)

-2.6

0.519

Wisconsin

32.7

(30.8–34.7)

31.7

(30.1–33.4)

32.8

(30.6–35.2)

0.3

0.948

Wyoming

32.4

(30.8–34.1)

34.3

(32.4–36.1)

32.7

(31.0–34.4)

0.9

0.804

Abbreviation: CI = confidence interval.

* Age-adjusted to the 2000 U.S. standard population; weighted estimates.

Not age-adjusted.

§ Persons identified as Hispanic might be of any race. Persons identified as white, black, Asian/Pacific Islander, or American Indian/Alaska Native are all non-Hispanic. The five racial/ethnic categories are mutually exclusive.


FIGURE. Age-adjusted* percentage of adults aged ≥18 years who had been screened for high blood cholesterol during the preceding 5 years and percentage who had ever been screened for cholesterol and were told by a health-care provider that they had high blood cholesterol — Behavioral Risk Factor Surveillance System, United States, 2009

The figure shows the age-adjusted percentage of adults aged ≥18 years who had been screened for high blood cholesterol during the preceding 5 years and the percentage who had ever been screened for cholesterol and were told by a health-care provider that they had high blood cholesterol. In general, prevalence of cholesterol screening in the United States in 2009 was higher among residents of eastern states than western states.

* Age-adjusted to the 2000 U.S. standard population; weighted estimates.

Alternate Text: The figure above shows the age-adjusted percentage of adults aged ≥18 years who had been screened for high blood cholesterol during the preceding 5 years and the percentage who had ever been screened for cholesterol and were told by a health-care provider that they had high blood cholesterol. In general, prevalence of cholesterol screening in the United States in 2009 was higher among residents of eastern states than western states.


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