Race/Ethnicity, Income, Major Risk Factors, and Cardiovascular Disease Mortality

Coordinating Centers for Biometric Research, University of Minnesota, 2221 University Ave SE, Suite 200, Minneapolis, MN 55414, USA.
American Journal of Public Health (Impact Factor: 4.55). 09/2005; 95(8):1417-23. DOI: 10.2105/AJPH.2004.048165
Source: PubMed


We explored differences between Black and White men for cardiovascular disease (CVD) mortality across major risk factor levels.
Major CVD risk factors were measured among 300,647 White and 20,223 Black men aged 35 to 57 years who were screened for the Multiple Risk Factor Intervention Trial (MRFIT). Hazard ratios for CVD deaths for Black and White men over 25 years of follow-up were calculated for subgroups stratified according to risk factor levels.
CVD was responsible for 2518 deaths among Black men and 30,772 deaths among White men. The age-adjusted Black-to-White CVD hazard ratio was 1.35 (95% confidence interval [CI]=1.29, 1.40); the risk- and income-adjusted ratio was 1.05 (95% CI=1.01, 1.10). CVD mortality rates were dramatically lower in cases of favorable risk profiles. However, fully adjusted Black-to-White CVD hazard ratios within groups at low, intermediate, high, and very high levels of overall risk were 1.76, 1.20, 1.10, and 0.94, respectively. Similar gradients were evident for individual risk factors.
Higher CVD mortality rates among Black men were largely mediated by risk factors and income. These data underscore the need for sustained primordial risk factor prevention among Black men.

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Available from: Avis Thomas, Mar 02, 2014
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    • "At the national level, there is extensive documentation of past, current, and persistent health inequalities [1] associated with most major chronic diseases among populations differing in socioeconomic status, race, ethnicity, gender, and age [2-5]. National input for Healthy People 2020 recommended expanded health goals and objectives designed to achieve health equity, eliminate disparities, and improve health [6]. "
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    ABSTRACT: The degree of health disparities present in rural communities is of growing concern and is considered "urgent" since rural residents lag behind their urban counterparts in health status. Understanding the prevalence and type of chronic diseases in rural communities is often difficult since Americans living in rural areas are reportedly less likely to have access to quality health care, although there are some exceptions. Data suggest that rural residents are more likely to engage in higher levels of behavioral and health risk-taking than urban residents, and newer evidence suggests that there are differences in health risk behavior within rural subgroups. The objective of this report is to characterize the prevalence of four major and costly chronic diseases (diabetes, cardiovascular disease, cancer, and arthritis) and putative risk factors including depressive symptoms within an understudied rural region of the United States. These four chronic conditions remain among the most common and preventable of health problems across the United States. Using survey data (N = 2526), logistic regression models were used to assess the association of the outcome and risk factors adjusting for age, gender, and race. Key findings are (1) Lower financial security was associated with higher prevalence of cardiovascular disease, arthritis, and diabetes, but not cancer. (2) Higher levels of depressive symptoms were associated with higher prevalence of cardiovascular disease, arthritis, and diabetes. (3) Former or current smoking was associated with higher prevalence of cardiovascular disease and cancer. (4) Blacks reported higher prevalence of diabetes than Whites; Black women were more likely to report diabetes than all other groups; prevalence of diabetes was greater among women with lower education than among women with higher education. (5) Overall, the prevalence of diabetes and arthritis was higher than that reported by Florida and national data. The findings presented in this paper are derived from one of only a few studies examining patterns of chronic disease among residents of both a rural and lower income geographic region. Overall, the prevalence of these conditions compared to the state and nation as a whole is elevated and calls for increased attention and tailored public health interventions.
    BMC Public Health 10/2013; 13(1):906. DOI:10.1186/1471-2458-13-906 · 2.26 Impact Factor
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    • "In the United States, racial and ethnic minorities are disproportionately affected by the HIV/AIDS epidemic. Many of the traditional risk factors for CVD such as hypertension, diabetes, and obesity are higher in the African-American population [8]. Clinical trials demographics often do not reflect the diverse nature of the HIV-positive population in the United States. "
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    BMC Infectious Diseases 06/2013; 13(1):269. DOI:10.1186/1471-2334-13-269 · 2.61 Impact Factor
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    • "Our experimental CBPR trial to explore the short- and long-term effectiveness of a community-based trial is unique in its approach of incorporating motivational interviewing. The magnitude of change seen at the 3-month measure is clinically meaningful in reducing cardiovascular disease (CVD), especially in a population that is primarily African American[66,67], and compares to findings from the NIH-sponsored Dietary Approaches to Stop Hypertension (DASH) and the PREMIER trials[56,57]. "
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    ABSTRACT: Community-based participatory research (CBPR) has been recognized as an important approach to develop and execute health interventions among marginalized populations, and a key strategy to translate research into practice to help reduce health disparities. Despite growing interest in the CBPR approach, CBPR initiatives rarely use experimental or other rigorous research designs to evaluate health outcomes. This behavioral study describes the conceptual frameworks, methods, and early findings related to the reach, adoption, implementation, and effectiveness on primary blood pressure outcomes. The CBPR, social support, and motivational interviewing frameworks are applied to test treatment effects of a two-phased CBPR walking intervention, including a 6-month active intervention quasi experimental phase and 12-month maintenance randomized controlled trial phase to test dose effects of motivational interviewing. A community advisory board helped develop and execute the culturally-appropriate intervention components which included social support walking groups led by peer coaches, pedometer diary self-monitoring, monthly diet and physical activity education sessions, and individualized motivational interviewing sessions. Although the study is on-going, three month data is available and reported. Analyses include descriptive statistics and paired t tests. Of 269 enrolled participants, most were African American (94%) females (85%) with a mean age of 43.8 (SD = 12.1) years. Across the 3 months, 90% of all possible pedometer diaries were submitted. Attendance at the monthly education sessions was approximately 33%. At the 3-month follow-up 227 (84%) participants were retained. From baseline to 3-months, systolic BP [126.0 (SD = 19.1) to 120.3 (SD = 17.9) mmHg; p < 0.001] and diastolic BP [83. 2 (SD = 12.3) to 80.2 (SD = 11.6) mmHg; p < 0.001] were significantly reduced. This CBPR study highlights implementation factors and signifies the community's active participation in the development and execution of this study. Reach and representativeness of enrolled participants are discussed. Adherence to pedometer diary self-monitoring was better than education session participation. Significant decreases in the primary blood pressure outcomes demonstrate early effectiveness. Importantly, future analyses will evaluate long-term effectiveness of this CBPR behavioral intervention on health outcomes, and help inform the translational capabilities of CBPR efforts.
    International Journal of Behavioral Nutrition and Physical Activity 06/2011; 8(1):59. DOI:10.1186/1479-5868-8-59 · 4.11 Impact Factor
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