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Disparities in Cardiovascular Disease Mortality Among U.S. Adults

Analyzing NHANES (National Health and Nutrition Examination Survey) data from 1999 to 2018, investigators find that a difference in cardiovascular disease (CVD) mortality between Black and White U.S. adults “diminished after adjustment for behavioral and metabolic risk factors and completely dissipated with adjustment for social determinants of health [(SDOH)].” The authors conclude, “Future research is warranted to understand the underlying mechanisms of SDOH on CVD mortality and develop novel interventions for reducing CVD mortality in populations, especially in Black persons.”

A prospective cohort design was used to assess a nationally representative sample of 50,808 persons aged 20 years or older. Social, behavioral, and metabolic factor data from the study periods show these associations after linking survey data with the National Death Index: “Over an average of 9.4 years of follow-up, 2,589 CVD deaths were confirmed. The age- and sex-standardized rates of CVD mortality were 484.7 deaths per 100,000 person-years in Black participants, 384.5 deaths per 100,000 person-years in White participants, 292.4 deaths per 100,000 person-years in Hispanic participants, and 255.1 deaths per 100,000 person-years in other race groups. In a multiple Cox regression analysis adjusted for all measured risk factors simultaneously, several social (unemployment, low family income, food insecurity, lack of home ownership, and unpartnered status), behavioral (current smoking, lack of leisure-time physical activity, and sleep <6 or >8 h/d), and metabolic (obesity, hypertension, and diabetes) risk factors were associated with a significantly higher risk for CVD death. After adjustment for these metabolic, behavioral, and social risk factors separately, hazard ratios of CVD mortality for Black compared with White participants were attenuated from 1.54 (95% CI, 1.34 to 1.77) to 1.34 (CI, 1.16 to 1.55), 1.31 (CI, 1.15 to 1.50), and 1.04 (CI, 0.90 to 1.21), respectively.”

Source: Annals of Internal Medicine