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

Area of Science:

• Public Health
• Epidemiology
• Cardiovascular Disease Research

Background:

• Significant disparities exist in cardiovascular disease (CVD) mortality rates between Black and White adults in the United States.
• Understanding the underlying factors contributing to these disparities is essential for developing targeted public health interventions.

Purpose of the Study:

• To identify and quantify the factors that explain the elevated Black:White CVD mortality rates among US adults.
• To analyze the differential impact of socioeconomic status and CVD risk factors on mortality across age groups.

Main Methods:

• Analysis of data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (2003-2017).
• Estimation of Black:White hazard ratios (HRs) for CVD mortality in participants younger than 65 and 65 years or older.
• Mediation analysis to assess the contribution of socioeconomic status and CVD risk factors to mortality differences.

Main Results:

• After full adjustment, the Black:White CVD mortality HR was 1.21 (95% CI: 1.00, 1.47) for those younger than 65 and 1.12 (95% CI: 0.97, 1.29) for those 65 or older.
• Socioeconomic status explained 21.2% and 38.0% of the Black:White CVD mortality risk difference in younger and older adults, respectively.
• CVD risk factors explained 56.6% and 41.3% of the Black:White CVD mortality difference in younger and older adults, respectively.

Conclusions:

• The higher CVD mortality risk observed in Black adults compared to White adults is primarily attributable to racial differences in socioeconomic status.
• Established cardiovascular disease risk factors also play a substantial role in explaining these mortality disparities across different age groups.
• These findings underscore the need for interventions addressing socioeconomic determinants and cardiovascular health to reduce racial inequities in CVD mortality.