Social, Behavioral, and Metabolic Risk Factors and Racial Disparities in Cardiovascular Disease Mortality in U.S....

Area of Science:

• Public Health
• Epidemiology
• Health Disparities

Background:

• Cardiovascular disease (CVD) mortality rates are disproportionately higher among the Black population in the United States compared to other racial and ethnic groups.
• Understanding the contributing factors to this disparity is crucial for developing targeted interventions.

Purpose of the Study:

• To investigate the association between social, behavioral, and metabolic risk factors and CVD mortality.
• To determine if racial differences in CVD mortality persist after accounting for these risk factors.

Main Methods:

• A prospective cohort study using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018.
• Included a nationally representative sample of 50,808 adults aged 20 years and older.
• CVD deaths were tracked through linkage with the National Death Index.

Main Results:

• Over a mean follow-up of 9.4 years, 2,589 CVD deaths occurred.
• Black participants had the highest age- and sex-standardized CVD mortality rate (484.7/100,000 person-years).
• Social, behavioral, and metabolic risk factors were all associated with increased CVD mortality risk. The Black-White CVD mortality hazard ratio decreased from 1.54 to 1.04 after adjusting for social determinants of health.

Conclusions:

• The disparity in CVD mortality between Black and White populations significantly decreased after adjusting for behavioral and metabolic risk factors.
• Adjustment for social determinants of health completely eliminated the Black-White difference in CVD mortality, underscoring their critical role.