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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    • "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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    • "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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