Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019

Abstract

Background: Black adults experience a disproportionately higher burden of cardiovascular risk factors and disease in comparison with White adults in the United States. Less is known about how sex-based disparities in cardiovascular mortality between these groups have changed on a national scale over the past 20 years, particularly across geographic determinants of health and residential racial segregation. Methods: We used CDC WONDER (Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research) to identify Black and White adults age ≥25 years in the United States from 1999 to 2019. We calculated annual age-adjusted cardiovascular mortality rates (per 100 000) for Black and White women and men, as well as absolute rate differences and rate ratios to compare the mortality gap between these groups. We also examined patterns by US census region, rural versus urban residence, and degree of neighborhood segregation. Results: From 1999 to 2019, age-adjusted mortality rates declined overall for both Black and White adults. There was a decline in age-adjusted cardiovascular mortality among Black (602.1 to 351.8 per 100 000 population) and White women (447.0 to 267.5), and the absolute rate difference (ARD) between these groups decreased over time (1999: ARD, 155.1 [95% CI, 149.9–160.3]; 2019: ARD, 84.3 [95% CI, 81.2–87.4]). These patterns were similar for Black (824.1 to 526.3 per 100 000) and White men (637.5 to 396.0; 1999: ARD, 186.6 [95% CI, 178.6–194.6]; 2019: ARD, 130.3 [95% CI, 125.6–135.0]). Despite this progress, cardiovascular mortality in 2019 was higher for Black women (rate ratio, 1.32 [95% CI, 1.30–1.33])— especially in the younger (age <65 years) subgroup (rate ratio, 2.28 [95% CI, 2.23–2.32])—as well as for Black men (rate ratio, 1.33 [95% CI, 1.32–1.34]), compared with their respective White counterparts. There was regional variation in cardiovascular mortality patterns, and the Black-White gap differed across rural and urban areas. Cardiovascular mortality rates among Black women and men were consistently higher in communities with high levels of racial segregation compared with those with low to moderate levels. Conclusions: During the past 2 decades, age-adjusted cardiovascular mortality declined significantly for Black and White adults in the United States, as did the absolute difference in death rates between these groups. Despite this progress, Black women and men continue to experience higher cardiovascular mortality rates than their White counterparts.

Excess Mortality and Years of Potential Life Lost Among Black People in the US from 1999 to 2020

“…The excess deaths and YPLL were elevated among most of the major causes of death, though heart disease was the most prominent. This is consistent with the findings from Kyalwazi and colleagues 32 who found that, despite a decline in the absolute difference, age-adjusted cardiovascular mortality rates were persistently higher among Black people when compared with White people from 1999 to 2019. It is likely that disparities in rates of hypertension control and other factors associated with heart disease are in part responsible for this excess loss of life.…”

Structural racism and health in the age of COVID‐19: A selective review with policy implications

“…Racial residential segregation increases exposure to other health damaging risks, including poor housing quality (Trounstine, 2020), environmental toxins (Bullard et al., 2008), crime (Krivo et al., 2015), differential law enforcement (Shields, 2018) and less effective schools (Quillian, 2014), among other disadvantages. The evidence linking severe disadvantage to birth outcomes and mortality from cancer, CVD and COVID‐19 are consistent (Franz et al., 2022; Greer et al., 2014; Kershaw & Albrecht, 2015; Kyalwazi et al., 2022; Torrats‐Espinosa, 2021).…”

“…Segregated Black communities have higher rates of preterm birth and LBW infants (Mehra et al., 2017). Segregated Black communities have higher rates of all‐cause mortality and cause‐specific mortality from homicide (Knopov et al., 2019), cancer (Pruitt et al., 2015), CVD (Kyalwazi et al., 2022), and COVID‐19 (Chen et al., 2022; Dalsania et al., 2022; Krieger et al., 2020; Pabayo et al., 2022; Pierce et al., 2021; Rogers et al., 2020; Siegel et al., 2022).…”

“…A review of segregation effects across the cancer continuum found consistent evidence that racial residential segregation is linked to cancer mortality among Black individuals (Fang & Tseng, 2018). Studies of cardiovascular deaths also suggest persistent associations of Black racial residential segregation to higher rates of CVD mortality (Greer et al., 2014; Kyalwazi et al., 2022).…”

Evaluating health outcomes in the treatment of hypothyroidism

“…The interplay between age, sex, race/ethnicity, and thyroid function, and their relationship between clinical outcomes, is made more complex by potential differences in the “normal” ranges of thyroid function between different sociodemographic groups ( 100 ). Furthermore, a large body of investigative work has been dedicated to defining and measuring sociodemographic and racial/ethnic disparities in clinical outcomes relevant to hypothyroidism, including cardiovascular morbidity/mortality and bone health ( 101 – 103 ). While there is no expectation that changes in thyroid hormone prescribing alone would ameliorate these disparities, any future studies examining sociodemographic disparities in clinical outcomes in the hypothyroid population would have to be interpreted within the context of these baseline differences.…”