Despite declines in heart disease deaths, racial gap remains

November 11, 2001

ANAHEIM, Calif. Nov. 11 - Despite recent declines in coronary heart disease (CHD) death rates, a disparity between African Americans and whites has increased, according to a study reported today at the American Heart Association's Scientific Sessions 2001 conference.

CHD death rates among both whites and blacks dropped over the last two decades, but the reduction was more modest in African Americans, says Zhi-Jie Zheng, M.D., Ph.D., an epidemiologist in the cardiovascular health program of the Centers for Disease Control and Prevention (CDC) in Atlanta.

"Over the past 30 to 50 years, CHD mortality has declined dramatically, but it seemed that the decline was slower in African Americans than in whites," says Zheng. "Our results confirm this. The reasons for the slower decline are not clear but could be attributed to more incidence of CHD in African Americans or to differences in medical care received by African Americans and whites."

The findings point toward a need for prevention programs tailored to the education, ethnicity and other characteristics of populations at increased risk for CHD, he says.

Researchers analyzed mortality data from U.S. Vital Statistics from 1979 to 1998. The black/white ratio for CHD mortality was used as a marker of racial disparity in deaths due to coronary disease. The 'black/white ratio' is a measure of CHD mortality in blacks in relation to whites (rate in blacks divided by rate in whites). A ratio of less than 1.00 reflected lower risk in African Americans, and a ratio greater than 1.00 reflected higher risk.

In 1979 the black/white ratio of CHD mortality in men was 0.77, but by 1998 the ratio had climbed 25 percent to 0.96. Among women the ratio was 0.93 in 1979 but rose 23 percent to 1.14 in 1998, indicating that the decrease in CHD mortality in black women had fallen behind that of white women.

Zheng emphasized that the increase in the ratio does not reflect an increase in the CHD death rate among African Americans but rather a slower decline in mortality compared to whites. Overall, CHD mortality declined by 33.3 percent in black men between 1979 and 1998, compared to 46.1 percent in white men. At the same time CHD mortality decreased by 26.5 percent in black women compared to 40.1 percent in white women.

The racial disparity widened and narrowed as a result of different patterns of CHD mortality in various age groups. In younger age groups, the disparity either increased or remained unchanged between 1979 and 1998.

The ratio of black to white female death rates dropped 9.2 percent for women age 35 to 44 between 1979 and 1998, yet black women still showed risk 146 percent higher than white women in 1998. The death rate ratio increased between 2 percent and 34 percent for other age brackets between 45 and over 85 in that time span. The female black/white ratio exceeded 1.00 in 1998 for all but the over 85 age group.

"Among the four race-gender groups we studied, black women had the slowest decline in CHD death rate over the period of time," says Zheng. "The reason for that is unclear. It may be related to a higher prevalence of cardiovascular disease risk factors, a lower rate of awareness of risk factors, reduced access to medical care or other issues."

In men ages 35 to 44, the ratio dipped by 2.8 percent, yet black men in this group still showed risk 40 percent higher than white men. In other age groups, the ratio of black to white death rates increased 21 percent to 35 percent.

"The difference in CHD mortality rates between blacks and whites aged 65 years and older decreased, indicating that the increase in risk of CHD death with age is now more alike between these groups. It will be important to understand the reasons for this change in order to mount more effective preventive programs," notes Zheng.

"CDC and our partners, including the American Heart Association, the Centers for Medicare and Medicaid Services, and the National Heart, Lung, and Blood Institute remain fully committed to accelerating the decline in heart disease deaths among African Americans," said George Mensah, MD, director of the CDC's cardiovascular health program and one of the co-authors. "Through coordinated media campaigns, support for local policies that promote heart-healthy behaviors, and greater sharing of our respective expertise and resources, we will work to eliminate this gap."
Other co-authors are: Janet B. Croft, Ph.D.; Darwin Labarthe, M.D., Ph.D., and Janice E. Williams, Ph.D., MPH.

For information November 10 - 14, call: Carole Bullock or Bridgette McNeill at the Hilton Anaheim Hotel
(714) 251-5801

Abstract 3700

NR01-1353 (SS2001/Zheng)

American Heart Association

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