Clinical research study
Higher Cardiovascular Disease Prevalence and Mortality among Younger Blacks Compared to Whites

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Abstract

Background

Blacks have higher rates of cardiovascular disease than whites. The age at which these differential rates emerge has not been fully examined.

Objective

We examined cardiovascular disease prevalence and mortality among black and white adults across the adult age spectrum and explored potential mediators of these differential disease prevalence rates.

Methods

We conducted a cross-sectional analysis of National Health and Nutrition Examination Survey data from 1999-2006. We estimated age-adjusted and age-specific prevalence ratios (PR) for cardiovascular disease (heart failure, stroke, or myocardial infarction) for blacks versus whites in adults aged 35 years and older and examined potential explanatory factors. From the National Compressed Mortality File 5-year aggregate file of 1999-2003, we determined age-specific cardiovascular disease mortality rates.

Results

In young adulthood, cardiovascular disease prevalence was higher in blacks than whites (35-44 years PR 1.9; 95% confidence interval [CI], 1.1-3.4). The black-white PR decreased with each decade of advancing age (P for trend = .04), leading to a narrowing of the racial gap at older ages (65-74 years PR 1.2; 95% CI, 0.8-1.6; ≥75 years PR 1.0; 95% CI, 0.7-1.4). Clinical and socioeconomic factors mediated some, but not all, of the excess cardiovascular disease prevalence among young to middle-aged blacks. Over a quarter (28%) of all cardiovascular disease deaths among blacks occurred in those aged <65 years, compared with 13% among whites.

Conclusions

Reducing black/white disparities in cardiovascular disease will require a focus on young and middle-aged blacks.

Section snippets

National Health and Nutrition Examination Survey

We combined data from the 1999-2006 waves of National Health and Nutrition Examination Survey (NHANES) data, a cross-sectional, nationally representative survey of the noninstitutionalized US civilian population administered by the National Center for Health Statistics.20 Details of recruitment and study procedures are published and available on the website.20 We focused on 2 racial groups, those who self-identified as non-Hispanic black or non-Hispanic white. We included participants who

Results

Blacks had higher age-adjusted prevalence of cardiovascular disease compared with whites (PR 1.5; 95% CI, 1.1-2.0) (Table 1). We observed a significant interaction between age and race (P = .04 for linear trend in the log odds ratio for blacks versus whites across 10-year age categories) (Figure 1). The black-white ratio decreased with each successive decade, with no prevalence differences in cardiovascular disease observed in the older decades.

Patterns were similar for each of the specific

Discussion

Racial differences in cardiovascular disease prevalence vary by age, with the largest black-white disparities observed in young to middle age. These racial differences in disease rates across the age spectrum are masked in the traditional age adjustment of disease rates. Our results highlight the importance of understanding the current epidemiology of disease patterns for research, clinical, and public health efforts aimed at reducing cardiovascular disease health disparities.

Prior studies have

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  • Cited by (0)

    Funding:Faculty Development in Primary Care-D55HP05165 grant (SJ) and the Harold Amos Medical Faculty Development Award (KBD). There was no pharmaceutical or industry funding for this manuscript.

    Conflict of Interest: None of the authors have any conflicts of interest to disclose related to this manuscript.

    Authorship: All authors had access to the data and a role in writing the manuscript.

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