The Health Conditions That Are Quietly Epidemic in Mississippi, And What Prevention Actually Looks Like

Type 2 Diabetes

Mississippi has the highest rate of diagnosed diabetes in the United States. Approximately 14 percent of Mississippi adults have been diagnosed with diabetes, a rate that exceeds the national average of approximately 11 percent, and the undiagnosed rate is estimated to add several additional percentage points to the true burden.

The risk factors that drive Mississippi’s diabetes rate are interconnected: the highest obesity rate in the nation, high rates of physical inactivity, dietary patterns with high caloric density and refined carbohydrate content, limited access to fresh produce in food desert communities, and genetic predisposition in populations with high rates of African ancestry.

What prevention actually looks like: The Diabetes Prevention Program, a landmark clinical trial that showed intensive lifestyle intervention reduces the progression from prediabetes to diabetes by 58 percent, produced its results through specific, structured behavioral changes: a minimum of 150 minutes of moderate physical activity per week and a modest reduction in body weight of 5 to 7 percent. These are not dramatic interventions. A 200 pound person achieving 5 to 7 percent weight reduction needs to lose 10 to 14 pounds. That is achievable.

What prevents prevention is not the magnitude of the change required, it is the lack of structured support for making it. The CDC recognized Diabetes Prevention Program is available in Mississippi through several health systems and community organizations.

Ask your pharmacist or physician whether you qualify for a CDC recognized Diabetes Prevention Program in your area. If you have been told you have prediabetes, a fasting blood glucose between 100 and 125 mg/dL, you qualify, and the program is covered by Medicare and many commercial insurance plans.

The pharmacy’s role in diabetes prevention: A pharmacist who knows your fasting blood glucose trend can identify when prediabetes is progressing toward diabetes before your next physician appointment. A pharmacist who knows your complete medication list can identify medications that are contributing to blood sugar elevation, corticosteroids, certain antipsychotics, certain blood pressure medications, and flag that contribution to your prescriber. A pharmacist who has your trust can have the honest conversation about metformin as a safe, inexpensive, well tolerated medication that reduces progression from prediabetes to diabetes by 31 percent in the DPP trial, a conversation that belongs in the clinical toolkit alongside lifestyle intervention, not instead of it.

Hypertension

High blood pressure affects approximately 44 percent of Mississippi adults, one of the highest rates in the nation. Mississippi’s hypertension burden is driven by many of the same factors as its diabetes burden, obesity, dietary sodium, physical inactivity, and stress, with the additional contribution of the highest rate of African American population of any state in the country.

Hypertension in African Americans has distinct clinical characteristics that are worth understanding. It tends to present earlier in life, progress more rapidly, and cause organ damage, particularly kidney disease and stroke, at higher rates than in other populations. The response to different antihypertensive medication classes also differs: ACE inhibitors and ARBs tend to be less effective as monotherapy in African Americans than in other populations, while calcium channel blockers and thiazide diuretics tend to be more effective. This is a clinical reality that should inform prescribing decisions and that many patients are never told about.

What prevention actually looks like: For hypertension, prevention and early treatment are nearly synonymous, because the damage from hypertension is cumulative and largely asymptomatic until it produces a stroke, a heart attack, or kidney failure.

The lifestyle modifications with the most evidence for blood pressure reduction are:

The DASH diet, Dietary Approaches to Stop Hypertension, which emphasizes fruits, vegetables, whole grains, lean protein, and low fat dairy while reducing sodium, saturated fat, and red meat. Adherence to the full DASH diet has been shown to reduce systolic blood pressure by 8 to 14 mmHg in clinical trials, a reduction comparable to a low dose antihypertensive medication.

Sodium reduction, specifically below 2,300 mg per day, with greater reductions producing greater blood pressure benefits in salt sensitive individuals. Mississippi dietary patterns, including processed foods, cured meats, fast food, and restaurant meals, are typically high in sodium. Awareness of hidden sodium sources is a practical first step.

Regular aerobic exercise, 150 minutes per week of moderate intensity, reduces blood pressure by 4 to 9 mmHg on average. The mechanism involves reduced vascular resistance, improved endothelial function, and reduced sympathetic nervous system activity.

Weight reduction, each kilogram of body weight lost is associated with approximately 1 mmHg reduction in systolic blood pressure. For overweight patients the blood pressure benefit of weight loss is additive to the cardiovascular benefit.

Limiting alcohol, more than two drinks per day is independently associated with elevated blood pressure and resistance to antihypertensive treatment.

The pharmacy’s role in hypertension management: Blood pressure monitoring at the pharmacy counter provides a touchpoint for hypertension management between physician appointments that is accessible, free, and immediate. At Fairview we offer walk in blood pressure checks without appointment. A patient whose blood pressure is consistently elevated between appointments can be identified and their physician notified before the next scheduled visit.

Medication adherence is the most actionable lever in hypertension management for patients already on antihypertensive therapy. A patient taking their blood pressure medication inconsistently, because of side effects, cost, forgetfulness, or the absence of symptoms that makes the medication feel unnecessary, has uncontrolled hypertension despite being ”on treatment.” Identifying adherence barriers and addressing them is a core pharmacy function that prevents strokes and heart attacks that would otherwise occur in patients who are technically prescribed appropriate therapy.

Cardiovascular Disease and Stroke

Mississippi has cardiovascular disease mortality rates that consistently rank among the highest in the nation. Stroke mortality in Mississippi is significantly above the national average, part of what epidemiologists call the ”Stroke Belt,” a region of the southeastern United States with persistently elevated stroke rates that has been documented since the 1940s.

The drivers of Mississippi’s cardiovascular and stroke burden are largely the same as the drivers of its diabetes and hypertension burden, because diabetes, hypertension, obesity, and physical inactivity are all independent cardiovascular risk factors, and their co occurrence in the same population produces a multiplicative rather than additive risk increase.

What prevention actually looks like: Cardiovascular disease prevention in Mississippi requires addressing the risk factor cluster, not managing each condition in isolation.

A patient with diabetes, hypertension, and dyslipidemia who is managed by three different specialists, an endocrinologist, a cardiologist, and a primary care physician, with no single clinician reviewing the integrated risk factor picture is receiving fragmented care that is less effective than coordinated management would be.

The pharmacist’s role in cardiovascular prevention is to be the clinician who sees the complete picture, every medication, every risk factor, every recent lab value the patient brings in, and who identifies the gaps, the interactions, and the optimization opportunities that no single specialist appointment provides.

Statin therapy and aspirin in Mississippi: Mississippi has high rates of patients who qualify for statin therapy under ACC/AHA cardiovascular risk guidelines but who are not on statins, either because they were never prescribed, because they stopped due to side effects, or because they do not have consistent access to the prescriber who would manage the therapy.

As we discussed in our statin CoQ10 post, statin associated muscle symptoms are the most common reason patients stop their statin, and CoQ10 supplementation is a safe, reasonable intervention for patients experiencing these symptoms that may allow them to continue a therapy that is genuinely protecting their cardiovascular health.

Low dose aspirin recommendations have changed significantly in recent years. The USPSTF updated its guidance in 2022 to recommend against initiating aspirin for primary prevention of cardiovascular disease in adults over 60, a change from previous guidelines that recommended aspirin for many patients in this age group. If you were prescribed aspirin for heart health more than a few years ago, ask your pharmacist or physician whether the recommendation applies to your current situation.

Chronic Kidney Disease

Chronic kidney disease, CKD, is directly downstream of Mississippi’s diabetes and hypertension epidemic. Diabetic nephropathy and hypertensive nephrosclerosis are the two most common causes of CKD and together account for the majority of new dialysis cases in the United States.

Mississippi has dialysis center density that reflects its burden of end stage kidney disease, the final stage of CKD where kidneys are no longer able to sustain life without dialysis or transplantation. End stage kidney disease is a preventable outcome in most cases, preventable through early identification and aggressive management of diabetes and hypertension before significant kidney damage has occurred.

What the pharmacy can do: The most impactful pharmacy interventions for CKD prevention are medication dose adjustments and medication avoidance.

Many medications are cleared by the kidneys and require dose reduction as kidney function declines. Metformin is the most clinically important example, it must be dose reduced and eventually discontinued at low kidney function levels because accumulation causes lactic acidosis. A patient whose kidney function has declined significantly since metformin was initiated and whose dose has not been adjusted is at risk for a preventable serious adverse event.

NSAIDs, ibuprofen, naproxen, are nephrotoxic with regular use in patients with existing kidney disease. A patient with CKD who is taking NSAIDs for chronic pain management is accelerating the progression of the kidney disease that is already present. This drug disease interaction requires identification and management, the kind of clinical review that happens in an MTM session but rarely in a routine prescription transaction.

Depression and Mental Health

Mississippi has limited mental health resources relative to its population need. Rates of depression, anxiety, and serious mental illness in Mississippi are above the national average while access to mental health professionals, psychiatrists, psychologists, licensed clinical social workers, is significantly below the national average, particularly in rural areas.

The practical consequence is a population with high rates of untreated and undertreated mental health conditions, high rates of psychiatric medication management by primary care physicians without specialist support, and significant rates of mental health crisis presentations in emergency rooms that could have been prevented with earlier intervention.

The pharmacy’s role: Pharmacists are not mental health clinicians. But pharmacists are often the most consistent professional point of contact for patients managing mental health conditions with medication, and a pharmacist who pays attention can identify warning signs that warrant escalation.

A patient who has not filled their antidepressant in two months, visible in the refill history, may have stopped taking it. A patient who has stopped taking their mood stabilizer may be approaching a manic episode. A patient who is filling a new benzodiazepine from a new prescriber while already on a long term benzodiazepine from their regular physician has a clinical situation that requires review.

Identifying these situations and responding with concern, without judgment, and with a specific next step, contact the prescriber, offer a counseling conversation, provide crisis resource information, is a pharmacy function that saves lives in a state where mental health crises are too common and mental health resources are too scarce.

The Common Thread Across All of These Conditions

Every health condition discussed in this post, diabetes, hypertension, cardiovascular disease, chronic kidney disease, and depression, is characterized by the same features in Mississippi:

It is more prevalent than the national average. It is more likely to present at an advanced stage due to delayed diagnosis. It is more likely to be managed with inadequate follow up due to healthcare access barriers. And it is more likely to respond to a trusted, consistent, community based clinical relationship than to episodic specialist care.

A pharmacist who has been in the same community for 48 years, who knows three generations of the same family, who has the complete medication picture and the clinical knowledge to use it, that pharmacist is not a supplement to the healthcare system in Mississippi. In many communities they are the healthcare system.

I take that responsibility seriously every day I open this pharmacy. It is why we are still here. And it is why the work described in this 52 post content library, educating, informing, empowering, and building trust with patients who deserve honest answers, matters as much to me as any prescription I have ever filled.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.