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Validation of reported myocardial infarction mortality in blacks and whites. A report from the Community
M H Lee1, N O Borhani, L H Kuller
1Department of Community Health, School of Medicine, University of California, Davis 95616.
Insights
Blacks have higher reported coronary heart disease (CHD) mortality, but this study found overall rates lower than whites. This difference may stem from higher case-fatality and misclassification of death causes in Black populations.
Area of Science:
- Cardiovascular Epidemiology
- Public Health
- Racial Disparities in Health
Background:
- Coronary heart disease (CHD) is a leading cause of death globally.
- Existing data suggest higher CHD mortality rates among Black populations compared to White populations.
- The accuracy of these reported disparities requires rigorous investigation.
Purpose of the Study:
- To investigate the accuracy of reported differences in CHD mortality between Black and White individuals.
- To analyze fatal and nonfatal coronary heart disease (CHD) and myocardial infarction (MI) events across racial groups.
- To identify potential factors contributing to observed disparities in CHD mortality rates.
Main Methods:
- Utilized data from the Community Cardiovascular Surveillance Program (CCSP) across 12 US communities.
- Applied standardized criteria to classify fatal and nonfatal cases of CHD and myocardial infarction (MI).
- Calculated age-adjusted annual mortality rates and proportions of definite MI for both fatal and nonfatal events by race and sex.
Main Results:
- Age-adjusted mortality rates for definite myocardial infarction (MI) were higher in Black men and women than in White men and women.
- However, the rates for nonfatal definite MI were higher in White individuals across both sexes.
- The overall rate for fatal and nonfatal definite MI was lower in Black individuals (215/100,000) compared to White individuals (244/100,000).
Conclusions:
- The study suggests that the commonly believed higher CHD mortality in Black populations may be overestimated.
- A higher case-fatality ratio combined with potential misclassification of the cause of death could contribute to this perception.
- Further research is needed to fully understand the complex interplay of factors influencing CHD outcomes in diverse populations.
Abstract:
It is widely believed that blacks experience a higher mortality due to coronary heart disease (CHD) than do whites. To determine whether this reported difference in mortality between blacks and whites is real, we studied the question in the context of the Community Cardiovascular Surveillance Program (CCSP). Fatal and nonfatal cases of CHD were reviewed in 12 US communities. Standardized criteria were applied to classify these cases as possible CHD, definite CHD, possible myocardial infarction (MI), or definite MI. The annual age-adjusted mortality rate per 100,000 ascribed to definite MI by the CCSP criteria was higher in blacks than in whites: 47 in white men (95% confidence interval, 36 to 58), 18 in white women (95% confidence interval, 8 to 28), 95 in black men (95% confidence interval, 10 to 180), and 41 for black women (95% confidence interval, 0 to 99). The proportion of definite MI to all fatal CHD events was higher in blacks (16%) than in whites (12%). For nonfatal events, however, the rate of definite MI was higher in whites than in blacks: 322 in white men (95% confidence interval, 293 to 351), 225 in black men (95% confidence interval, 160 to 290), 82 in black women (95% confidence interval, 43 to 121), and 103 in white women (95% confidence interval, 88 to 118). The proportion of definite MI to all nonfatal CHD events was lower in blacks (16%) than in whites (30%). Thus, the overall rate for fatal and nonfatal definite MI was lower in blacks (215/100,000) than in whites (244/100,000). These observations suggest that a combination of high case-fatality ratio and misclassification of cause and death may contribute to the reported higher rate of CHD mortality among blacks.