Decomposing Black-White Disparities in Heart Disease Mortality in the United States, 1973–2010: An Age-Period-Cohort Analysis

Kramer, Michael R.; Valderrama, Amy L.; Casper, Michele

doi:10.1093/aje/kwv050

Cited by 52 publications

(72 citation statements)

References 43 publications

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“…In contrast to sex differences, previous studies have suggested that biological differences between racial groups contribute little to the differences in outcomes, which are driven largely by differences in socioeconomic well‐being and quality of care at hospitals where black patients seek care 6, 26, 27, 28, 29, 30, 31, 32. The continued high post‐CABG mortality in black patients merits further investments in targeting hospital‐level quality improvement interventions, as well as in strengthening systems for transitions of care outside the hospital and developing community support interventions that support this unique sociocultural group.…”

Section: Discussionmentioning

confidence: 99%

Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014

Angraal

Khera

Wang

et al. 2018

JAHA

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BackgroundWith over a decade of directed efforts to reduce sex and racial differences in coronary artery bypass grafting (CABG) utilization, and post‐CABG outcomes, we sought to evaluate how the use of CABG and its outcomes have evolved in different sex and racial subgroups.Methods and ResultsUsing data on all fee‐for‐service Medicare beneficiaries undergoing CABG in the United States from 1999 to 2014, we examined differences by sex and race in calendar‐year trends for CABG utilization and post‐CABG outcomes (in‐hospital, 30‐day, and 1‐year mortality and 30‐day readmission). A total of 1 863 719 Medicare fee‐for‐service beneficiaries (33.6% women, 4.6% black) underwent CABG from 1999 to 2014, with a decrease from 611 to 245 CABG procedures per 100 000 person‐years. Men compared with women and whites compared with blacks had higher CABG utilization, with declines in all subgroups. Higher post‐CABG annual declines in mortality (95% confidence interval) were observed in women (in‐hospital, −2.70% [−2.97, −2.44]; 30‐day, −2.29% [−2.54, −2.04]; and 1‐year mortality, −1.67% [−1.88, −1.46]) and blacks (in‐hospital, −3.31% [−4.02, −2.60]; 30‐day, −2.80% [−3.49, −2.12]; and 1‐year mortality, −2.38% [−2.92, −1.84]), compared with men and whites, respectively. Mortality rates remained higher in women and blacks, but differences narrowed over time. Annual adjusted 30‐day readmission rates remained unchanged for all patient groups.ConclusionsWomen and black patients had persistently higher CABG mortality than men and white patients, respectively, despite greater declines over the time period. These findings indicate progress, but also the need for further progress.

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Section: Discussionmentioning

confidence: 99%

Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014

Angraal

Khera

Wang

et al. 2018

JAHA

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“…Well-documented racial health disparities in CVD burden and outcomes may also account for our findings. Black people have higher burdens of CVD at younger ages when compared with other races/ethnicities, and significant disparities are well-documented in treatment, diagnosis, access to care, and risk factors for CVD (7,8). …”

Section: Discussionmentioning

confidence: 99%

“…Such favorable neighborhood conditions are associated with healthy diet and exercise behaviors and reduced risk for CVD (3–6). Low-income and minority neighborhoods have poor access to healthy food and are less likely to be walkable; these factors may contribute to the well-established racial and socioeconomic disparities in CVD outcomes (7,8). …”

Section: Introductionmentioning

confidence: 99%

Neighborhood Environmental Health and Premature Death From Cardiovascular Disease

Gaglioti

Rollins

et al. 2018

Prev. Chronic Dis.

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IntroductionCardiovascular disease (CVD) is the leading cause of death in the United States and disproportionately affects racial/ethnic minority groups. Healthy neighborhood conditions are associated with increased uptake of health behaviors that reduce CVD risk, but minority neighborhoods often have poor food access and poor walkability. This study tested the community-driven hypothesis that poor access to food at the neighborhood level and poor neighborhood walkability are associated with racial disparities in premature deaths from CVD.MethodsWe examined the relationship between neighborhood-level food access and walkability on premature CVD mortality rates at the census tract level for the city of Atlanta using multivariable logistic regression models. We produced maps to illustrate premature CVD mortality, food access, and walkability by census tract for the city.ResultsWe found significant racial differences in premature CVD mortality rates and geographic disparities in food access and walkability among census tracts in Atlanta. Improved food access and walkability were associated with reduced overall premature CVD mortality in unadjusted models, but this association did not persist in models adjusted for census tract population composition and poverty. Census tracts with high concentrations of minority populations had higher levels of poor food access, poor walkability, and premature CVD mortality.ConclusionThis study highlights disparities in premature CVD mortality and neighborhood food access and walkability at the census tract level in the city of Atlanta. Improving food access may have differential effects for subpopulations living in the same area. These results can be used to calibrate neighborhood-level interventions, and they highlight the need to examine race-specific health outcomes.

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“…Over the past 40 years, heart disease mortality in the United States has declined sharply across race, gender, and age groups [1,2], with similarly strong declines occurring at the county level [3,4]. Recent national trends, however, indicate a slowing and even slight increase in heart disease mortality [5–7].…”

Section: Introductionmentioning

confidence: 99%

Widespread recent increases in county-level heart disease mortality across age groups

Vaughan

Ritchey

Hannan

et al. 2017

Annals of Epidemiology

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Purpose Recent national trends show decelerating declines in heart disease mortality, especially among younger adults. National trends may mask variation by geography and age. We examined recent county-level trends in heart disease mortality by age group. Methods Using a Bayesian statistical model and National Vital Statistics Systems data, we estimated overall rates and percent change in heart disease mortality from 2010 through 2015 for four age groups (35–44, 45–54, 55–64, and 65–74 years) in 3098 US counties. Results Nationally, heart disease mortality declined in every age group except ages 55–64 years. County-level trends by age group showed geographically widespread increases, with 52.3%, 58.5%, 69.1%, and 42.0% of counties experiencing increases with median percent changes of 0.6%, 2.2%, 4.6%, and −1.5% for ages 35–44, 45–54, 55–64, and 65–74 years, respectively. Increases were more likely in counties with initially high heart disease mortality and outside large metropolitan areas. Conclusions Recent national trends have masked local increases in heart disease mortality. These increases, especially among adults younger than age 65 years, represent challenges to communities across the country. Reversing these trends may require intensification of primary and secondary prevention—focusing policies, strategies, and interventions on younger populations, especially those living in less urban counties.

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Decomposing Black-White Disparities in Heart Disease Mortality in the United States, 1973–2010: An Age-Period-Cohort Analysis

Cited by 52 publications

References 43 publications

Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014

Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014

Neighborhood Environmental Health and Premature Death From Cardiovascular Disease

Widespread recent increases in county-level heart disease mortality across age groups

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