Black-White Differences in Incident Fatal, Nonfatal, and Total Coronary Heart Disease
Lisandro D Colantonio1, Christopher M Gamboa1, Joshua S Richman1
1From Department of Epidemiology, School of Public Health (L.D.C., E.B.L.), Department of Medicine, School of Medicine (C.M.G.), Department of Surgery, School of Medicine (J.S.R.), Department of Biostatistics, School of Public Health (G.H.), University of Alabama at Birmingham; Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); and Department of Medicine, Weill Cornell Medical College, New York (M.M.S.).
Insights
Black and white individuals have similar risks for fatal coronary heart disease (CHD) after accounting for risk factors. However, nonfatal CHD risk is lower in Black men and women compared to White individuals.
Area of Science:
- Cardiovascular epidemiology
- Health disparities research
- Clinical outcomes analysis
Background:
- Blacks exhibit higher coronary heart disease (CHD) mortality rates than Whites.
- Previous research indicated potentially lower nonfatal CHD risk in Black men compared to White men.
Purpose of the Study:
- To compare fatal and nonfatal CHD incidence and case-fatality between Black and White individuals across different age groups and sexes.
- To investigate the influence of social determinants of health and cardiovascular risk factors on these disparities.
Main Methods:
- Analysis of data from three large cohort studies: Atherosclerosis Risk in Communities (ARIC), Cardiovascular Health Study (CHS), and Reasons for Geographic and Racial Differences in Stroke (REGARDS).
- Inclusion of participants aged 45-64 and ≥65 years, without prior CHD history.
- Assessment of fatal and nonfatal CHD incidence and case-fatality over up to 11 years of follow-up, with statistical adjustments for covariates.
Main Results:
- Age-adjusted analyses showed higher fatal CHD risk for Black men and women compared to Whites.
- After adjusting for social determinants and risk factors, fatal CHD risk became similar between racial groups.
- Nonfatal CHD incidence was consistently lower for Black men and women compared to Whites, even after multivariable adjustment.
- CHD case-fatality was higher in Black individuals (men and women) compared to Whites, with this difference persisting after adjustments.
Conclusions:
- Adjusting for social determinants of health and cardiovascular risk factors reveals similar fatal coronary heart disease (CHD) risk between Black and White men and women.
- The risk for nonfatal CHD is consistently lower among Black individuals compared to White individuals, irrespective of sex.
Background:
Blacks have higher coronary heart disease (CHD) mortality compared with whites. However, a previous study suggests that nonfatal CHD risk may be lower for black versus white men.
Methods:
We compared fatal and nonfatal CHD incidence and CHD case-fatality among blacks and whites in the Atherosclerosis Risk in Communities study (ARIC), the Cardiovascular Health Study (CHS), and the Reasons for Geographic and Racial Differences in Stroke study (REGARDS) by sex. Participants 45 to 64 years of age in ARIC (men=6479, women=8488) and REGARDS (men=5296, women=7822), and ≥65 years of age in CHS (men=1836, women=2790) and REGARDS (men=3381, women=4112), all without a history of CHD, were analyzed. Fatal and nonfatal CHD incidence was assessed from baseline (ARIC=1987-1989, CHS=1989-1990, REGARDS=2003-2007) through up to 11 years of follow-up.
Results:
Age-adjusted hazard ratios comparing black versus white men 45 to 64 years of age in ARIC and REGARDS were 2.09 (95% confidence interval, 1.42-3.06) and 2.11 (1.32-3.38), respectively, for fatal CHD, and 0.82 (0.64-1.05) and 0.94 (0.69-1.28), respectively, for nonfatal CHD. After adjustment for social determinants of health and cardiovascular risk factors, hazard ratios in ARIC and REGARDS were 1.19 (95% confidence interval, 0.74-1.92) and 1.09 (0.62-1.93), respectively, for fatal CHD, and 0.64 (0.47-0.86) and 0.67 (0.48-0.95), respectively, for nonfatal CHD. Similar patterns were present among men ≥65 years of age in CHS and REGARDS. Among women 45 to 64 years of age in ARIC and REGARDS, age-adjusted hazard ratios comparing blacks versus whites were 2.61 (95% confidence interval, 1.57-4.34) and 1.79 (1.06-3.03), respectively, for fatal CHD, and 1.47 (1.13-1.91) and 1.29 (0.91-1.83), respectively, for nonfatal CHD. After multivariable adjustment, hazard ratios in ARIC and REGARDS were 0.67 (95% confidence interval, 0.36-1.24) and 1.00 (0.54-1.85), respectively, for fatal CHD, and 0.70 (0.51-0.97) and 0.70 (0.46-1.06), respectively, for nonfatal CHD. Racial differences in CHD incidence were attenuated among older women. CHD case fatality was higher among black versus white men and women, and the difference remained similar after multivariable adjustment.
Conclusions:
After accounting for social determinants of health and risk factors, black men and women have similar risk for fatal CHD compared with white men and women, respectively. However, the risk for nonfatal CHD is consistently lower for black versus white men and women.
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