Big Isle stroke
deaths targeted

A project in Waimea aims
to improve the island’s
poor profile

North Hawaii Community Hospital has established a Hawaii Heart Brain Center to try to reduce the Big Island's stroke and cardiovascular death rates -- highest in the state.

Dr. Ken Riff, the center's executive director, said its vision is to make North Hawaii "the healthiest cardiovascular community on earth."

He said the Waimea hospital began putting the center together in October in response to the high death rates.

Data collected by the North Hawaii Outcomes Project shows Hawaii County had a three-year average of 90 deaths due to stroke per 100,000 population in 2002, compared with about 65 for the state and 56 nationally.

In 2000 the Big Island's death rate from cardiovascular disease was 320 per 100,000 population, compared with 280 for the state and 340 nationally.

The Healthy Hawaii 2010 goal is no more than 48 stroke-caused deaths per 100,000 people, Riff pointed out.

He said the Hawaii Heart Brain Center will work with people in the community to increase understanding of risk factors for heart disease and stroke.

"Many of the risk factors are the same: smoking, high cholesterol and blood pressure, obesity, diabetes, lack of activity," Riff said.

The center also plans to conduct screenings at health fairs and other community events to identify people at risk for the diseases and refer them for treatment.

"Ultimately we hope to see few heart attacks and strokes," Riff said.

The center is expected to offer a number of services, including in women's cardiovascular health.

He said the hospital will kick off a campaign this fall to raise funds to update its CAT scanner and expand diagnostic procedures.

Riff said the Heart Brain Center is working closely with Dr. Sharon Vitousek's North Hawaii Outcomes Project, which is collecting health data and analyzing trends and risk factors.

Vitousek cites multiple reasons for the high stroke and heart death rate on the Big Island, including an inadequate number of primary-care physicians, which affects access to care.

The island also has a little higher smoking rate and perhaps less physical activity, "which may be related to cost-of-living issues and the fact that more people on the Big Island work at two jobs," she said. Ethnicity also might play a factor. The Big Island has a higher population of native Hawaiians, who have a higher diabetes rate.

Income disparity is another issue, Vitousek said, noting that national studies show higher death rates from stroke in counties with big gaps between the highest 20 percent and lowest 20 percent income groups.

"That may again relate to stress associated with poverty and multiple jobs."

She said the big issue is hypertension. There is not enough information to show if the Big Island has higher rates of hypertension than the other islands, she said, "but because we have a lower number of primary-care physicians, we may be underdiagnosing and undertreating hypertension.

"And if you can do only one thing to reduce stroke death rate, it would be identifying and better managing hypertension."

Low medical reimbursements that keep doctors from practicing on the Big Island contribute to the situation, Vitousek added.

The North Hawaii Outcomes Project began in 1999 as a community-based effort to improve health in the region and track improvements. It is sponsored by Five Mountains Hawaii and the Earl and Doris Bakken Foundation with the North Hawaii Community Hospital, Tutu's House, Health Maps and the Kohala Center.