Widening Socioeconomic and Racial Disparities in Cardiovascular Disease Mortality in the United States, 1969-2013

Abstract

Objectives:This study examined trends and socioeconomic and racial/ethnic disparities in cardiovascular disease (CVD) mortality in the United States between 1969 and 2013.Methods:National vital statistics data and the National Longitudinal Mortality Study were used to estimate racial/ethnic and area- and individual-level socioeconomic disparities in CVD mortality over time. Rate ratios and log-linear regression were used to model mortality trends and differentials.Results:Between 1969 and 2013, CVD mortality rates decreased by 2.66% per year for whites and 2.12% for blacks. Racial disparities and socioeconomic gradients in CVD mortality increased substantially during the study period. In 2013, blacks had 30% higher CVD mortality than whites and 113% higher mortality than Asians/Pacific Islanders. Compared to those in the most affluent group, individuals in the most deprived area group had 11% higher CVD mortality in 1969 but 40% higher mortality in 2007-2011. Education, income, and occupation were inversely associated with CVD mortality in both men and women. Men and women with low education and incomes had 46-76% higher CVD mortality risks than their counterparts with high education and income levels. Men in clerical, service, farming, craft, repair, construction, and transport occupations, and manual laborers had 30-58% higher CVD mortality risks than those employed in executive and managerial occupations.Conclusions and Global Health Implications:Socioeconomic and racial disparities in CVD mortality are marked and have increased over time because of faster declines in mortality among the affluent and majority populations. Disparities in CVD mortality may reflect inequalities in the social environment, behavioral risk factors such as smoking, obesity, physical inactivity, disease prevalence, and healthcare access and treatment. With rising prevalence of many chronic disease risk factors, the global burden of cardiovascular diseases is expected to increase further, particularly in low- and middle-income countries where over 80% of all CVD deaths occur.

Increasing Area Deprivation and Socioeconomic Inequalities in Heart Disease, Stroke, and Cardiovascular Disease Mortality Among Working Age Populations, United States, 1969-2011

“…Socioeconomic inequalities in CVD, heart disease, and stroke mortality among the working-age population shown here are substantially greater than those for the overall US population as reported in the companion paper 23. Such age-related patterns in socioeconomic inequalities in health and mortality have also been noted for other industrialized countries.…”

Preventive parenting intervention during childhood and young black adults’ unhealthful behaviors: a randomized controlled trial

“…Similarly, excessive weight gain forecasts cardiovascular disease, stroke, and some cancers (Kramer, Valderrama, & Casper, ). Some of the highest rates of morbidity and mortality from these diseases occur in lower‐income Black communities in the rural southeastern United States (Singh, Siahpush, Azuine, & Williams, ). Thus, understanding the factors, such as receipt of supportive parenting, that may help buffer these young people from unhealthful behavioral trajectories before they enter young adulthood is crucial.…”

To move or not to move? Exploring the relationship between residential mobility, risk of cardiovascular disease and ethnicity in New Zealand

“…In the US in 2013, Black 33 groups had 30% higher mortality from CVD than Whites, increasing to 113% higher CVD mortality 34 than Asians and Pacific Islanders (Singh et al, 2015). 35…”