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

Author:

Tajeu Gabriel S.1,Safford Monika M.1,Howard George1,Howard Virginia J.1,Chen Ligong1,Long D. Leann1,Tanner Rikki M.1,Muntner Paul1

Affiliation:

1. Gabriel S. Tajeu is with the Department of Health Services Administration and Policy, Temple University, Philadelphia, PA. Monika M. Safford is with the Department of Medicine, Weill Cornell Medical College, New York, NY. George Howard and D. Leann Long are with the Department of Biostatistics, University of Alabama at Birmingham. Virginia J. Howard, Ligong Chen, Rikki M. Tanner, and Paul Muntner are with the Department of Epidemiology, University of Alabama at Birmingham.

Abstract

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.

Publisher

American Public Health Association

Subject

Public Health, Environmental and Occupational Health

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