Demographic and biologic influences on survival in whites and blacks: 40 years of follow-up in the Charleston heart study

Springer Science and Business Media LLC - Tập 5 - Trang 1-8 - 2006
Paul J Nietert1, Susan E Sutherland2, Julian E Keil1, David L Bachman3
1Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, USA
2Research Institute, Mission Hospitals, Inc, Asheville, USA
3Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA

Tóm tắt

In the United States, life expectancy is significantly lower among blacks than whites. We examined whether socioeconomic status (SES) and cardiovascular disease (CVD) risk factors may help explain this disparity. Forty years (1961 through 2000) of all-cause mortality data were obtained on a population-based cohort of 2,283 subjects in the Charleston Heart Study (CHS). We examined the influence of SES and CVD risk factors on all-cause mortality. Complete data were available on 98% of the original sample (647 white men, 728 white women, 423 black men, and 443 black women). After adjusting for SES and CVD risk factors, the hazard ratios (HRs) for white ethnicity were 1.14 (0.98 to 1.32) among men and 0.90 (0.75 to 1.08) among women, indicating that the mortality risk was 14% greater for white men and 10% lower for white women compared to their black counterparts. However the differences were not statistically significant. While there are marked contrasts in mortality among blacks and whites in the CHS, the differences can be largely explained by SES and CVD risk factors. Continued focus on improving and controlling cardiovascular disease risk factors may reduce ethnic disparities in survival.

Tài liệu tham khảo

National Center for Health Statistics. United States Life Tables, 2001. Accessed 4-5-2004, [http://www.cdc.gov/nchs/data/dvs/lt2001.pdf] Institute of Medicine: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. 2002, Washington, DC: National Academy Press Williams JE, Massing M, Rosamond WD, Sorlie PD, Tyroler HA: Racial disparities in CHD mortality from 1968-1992 in the state economic areas surrounding the ARIC study communities. Atherosclerosis Risk in Communities. Ann Epidemiol. 1999, 9: 472-480. 10.1016/S1047-2797(99)00029-0. Armstrong DL, Strogatz D, Wang R: United States coronary mortality trends and community services associated with occupational structure, among blacks and whites, 1984-1998. Soc Sci Med. 2004, 58: 2349-2361. 10.1016/j.socscimed.2003.08.030. Williams DR: Race, socioeconomic status, and health. The added effects of racism and discrimination. Ann N Y Acad Sci. 1999, 896: 173-188. 10.1111/j.1749-6632.1999.tb08114.x. Whittle J, Conigliaro J, Good CB, Lofgren RP: Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. New Engl J Med. 1993, 329: 621-627. 10.1056/NEJM199308263290907. McBean AM, Gornick M: Differences by race in the rates of procedures performed in hospitals for Medicare beneficiaries. Health Care Financing Review. 1994, 15: 77-90. Kaplan GA, Keil JE: Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993, 88: 1973-1998. Feinstein JS: The relationship between socioeconomic status and health: a review of the literature. Milbank Q. 1993, 71: 279-322. Keil JE, Sutherland SE, Knapp RG, Tyroler HA: Does equal socioeconomic status in black and white men mean equal risk of mortality?. Am J Public Health. 1992, 82: 1133-1136. Hames CG, Rose K, Knowles M, Davis CE, Tyroler HA: Black-white comparisons of 20-year coronary heart disease mortality in the Evans County Heart Study. Cardiology. 1993, 82: 122-136. Howard G, Anderson RT, Russell G, Howard VJ, Burke GL: Race, socioeconomic status, and cause-specific mortality. Ann Epidemiol. 2000, 10: 214-223. 10.1016/S1047-2797(00)00038-7. Koskinen S, Martelin T: Why are socioeconomic mortality differences smaller among women than among men?. Soc Sci Med. 1994, 38: 1385-1396. 10.1016/0277-9536(94)90276-3. Mustard CA, Etches J: Gender differences in socioeconomic inequality in mortality. Journal of Epidemiology and Community Health. 2003, 57: 974-980. 10.1136/jech.57.12.974. Thurston RC, Kubzansky LD, Kawachi I, Berkman LF: Is the association between socioeconomic position and coronary heart disease stronger in women than in men?. Am J Epi. 2005, 162: 57-65. 10.1093/aje/kwi159. Keil JE, Sutherland SE, Knapp RG, Lackland DT, Gazes PC, Tyroler HA: Mortality rates and risk factors for coronary disease in black as compared with white men and women. New Engl J Med. 1993, 329: 73-78. 10.1056/NEJM199307083290201. Boyle E: Biological patterns in hypertension by race, sex, body weight, and skin color. JAMA. 1970, 213: 1637-1643. 10.1001/jama.213.10.1637. Social Security Death Index. Accessed 4-5-2004, [http://ssdi.genealogy.rootsweb.com] National Center for Health Statistics. Death rates for selected causes of death by 10-year age groups, race and sex: death registration states, 1900-1932, and United States, 1933-1998. Accessed 5-18-2004, [http://www.cdc.gov/nchs/datawh/statab/unpubd/mortabs/hist290.htm] Keil JE, Sutherland SE, Hames CG, Lackland DT, Gazes PC, Knapp RG, Tyroler HA: Coronary disease mortality and risk factors in black and white men. Results from the combined Charleston, SC, and Evans County, Georgia, heart studies. Arch Intern Med. 1995, 155: 1521-1527. 10.1001/archinte.155.14.1521. Ding J, Diez Roux AV, Nieto FJ, McNamara RL, Hetmanski JB, Taylor HA, Tyroler HA: Racial disparity in long-term mortality rate after hospitalization for myocardial infarction: the Atherosclerosis Risk in Communities study. Am Heart J. 2003, 146: 459-464. 10.1016/S0002-8703(03)00228-X. Godley PA, Schenck AP, Amamoo MA, Schoenbach VJ, Peacock S, Manning M, Symons M, Talcott JA: Racial differences in mortality among Medicare recipients after treatment for localized prostate cancer. J Natl Cancer Inst. 2003, 95: 1702-1710. Marbella AM, Layde PM: Racial trends in age-specific breast cancer mortality rates in US women. Am J Public Health. 2001, 91: 118-121. Barnett E, Casper ML, Halverson JA, Elmes GA, Braham VE, Majeed ZA, Bloom AS, Stanley S: Men and Heart Disease: An Atlas of Racial and Ethnic Disparities in Mortality. 2001, Morgantown, WV: Office for Social Environment and Health Research, West Virginia University, 1 Casper ML, Barnett E, Halverson JA, Elmes GA, Braham VE, Majeed ZA, Bloom AS, Stanley S: Women and Heart Disease: An Atlas of Racial and Ethnic Disparities in Mortality. 2000, Morgantown, WV: Office for Social Environment and Health Research, West Virginia University, 2 Ayala C, Greenlund KJ, Croft JB, Keenan NL, Donehoo RS, Giles WH, Kittner SJ, Marks JS: Racial/ethnic disparities in mortality by stroke subtype in the United States, 1995-1998. Am J Epidemiol. 2001, 154: 1057-1063. 10.1093/aje/154.11.1057. National Academy on Aging. One in four: child poverty in America. The Public Policy and Aging Report 8. 1997. Bindman AB, Grumbach K, Osmond D, Komaromy M, Vranizan K, Lurie N, Billings J, Stewart A: Preventable hospitalizations and access to health care. JAMA. 1995, 274: 305-311. 10.1001/jama.274.4.305. Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J: Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA. 1998, 279: 1703-1708. 10.1001/jama.279.21.1703. Lantz PM, Lynch JW, House JS, Lepkowski JM, Mero RP, Musick MA, Williams DR: Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors. Soc Sci Med. 2001, 53: 29-40. 10.1016/S0277-9536(00)00319-1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003, 289: 2560-2572. 10.1001/jama.289.19.2560. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002, 106: 3143-3421. Diabetes Quality Improvement Project, Initial Measure Set (Final Version). Accessed 6-18-2004, [http://www.ncqa.org/dprp/dqip2.htm]