Black-White Differences in Cardiovascular Disease Mortality: A Prospective US Study, 2003-2017.

Publisher: American Public Health Association Country of Publication: United States NLM ID: 1254074 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1541-0048 (Electronic) Linking ISSN: 00900036 NLM ISO Abbreviation: Am J Public Health Subsets: MEDLINE

Publication: Washington, DC : American Public Health Association
Original Publication: New York [etc.]

Black or African American/*statistics & numerical data ; Cardiovascular Diseases/*ethnology ; White People/*statistics & numerical data; Age Distribution ; Age Factors ; Aged ; Aged, 80 and over ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases/mortality ; Comorbidity ; Female ; Health Behavior ; Humans ; Lipids/blood ; Male ; Middle Aged ; Proportional Hazards Models ; Risk Factors ; Sex Distribution ; Socioeconomic Factors ; United States/epidemiology

Objectives. To determine factors that explain the higher Black:White cardiovascular disease (CVD) mortality rates among US adults. Methods. We analyzed data from the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2017 to estimate Black:White hazard ratios (HRs) for CVD mortality within subgroups younger than 65 years and aged 65 years or older. Results. Among 29 054 participants, 41.0% who were Black and 54.9% who were women, 1549 CVD deaths occurred. Among participants younger than 65 years, the demographic-adjusted Black:White CVD mortality HR was 2.23 (95% confidence interval [CI] = 1.87, 2.65) and 1.21 (95% CI = 1.00, 1.47) after full adjustment. Among participants aged 65 years or older, the demographic-adjusted Black:White CVD mortality HR was 1.58 (95% CI = 1.39, 1.79) and 1.12 (95% CI = 0.97, 1.29) after full adjustment. When we used mediation analysis, socioeconomic status explained 21.2% (95% CI = 13.6%, 31.4%) and 38.0% (95% CI = 20.9%, 61.7%) of the Black:White CVD mortality risk difference among participants younger than 65 years and aged 65 years or older, respectively. CVD risk factors explained 56.6% (95% CI = 42.0%, 77.2%) and 41.3% (95% CI = 22.9%, 65.3%) of the Black:White CVD mortality difference for participants younger than 65 years and aged 65 years or older, respectively. Conclusions. The higher Black:White CVD mortality risk is primarily explained by racial differences in socioeconomic status and CVD risk factors.

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K01 HL151974 United States HL NHLBI NIH HHS; P30 DK079626 United States DK NIDDK NIH HHS; R01 DK108628 United States DK NIDDK NIH HHS; U01 NS041588 United States NS NINDS NIH HHS; R01 HL080477 United States HL NHLBI NIH HHS; L30 HL148987 United States HL NHLBI NIH HHS

0 (Lipids)

Date Created: 20200320 Date Completed: 20200630 Latest Revision: 20230413

20240513

PMC7144446

10.2105/AJPH.2019.305543

32191519