Department of Neurology, University of Alabama at Birmingham, 1235 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35294-0021, USA.
Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
J Racial Ethn Health Disparities. 2016 Dec;3(4):599-607. doi: 10.1007/s40615-015-0179-7. Epub 2015 Nov 5.
We evaluated whether differences in cardiovascular risk factors, as assessed by the Framingham risk scores for stroke and cardiovascular disease (FSRS and FCRS), contributed to disparities in all-cause mortality across race and regional strata of USA.
Race-region-specific FSRS and FCRS scores were computed for 30,086 REGARDS participants who were recruited between January 2003 and October 2007. They were divided across six regions of the "Eight Americas" and then compared after adjusting for race and sex. Kaplan-Meier curves and hazard ratios for all-cause mortality were estimated between regions, first adjusted for age and sex, and then for the risk scores.
After adjustment for age, sex, FCRS, and FSRS, there was no difference in mortality among Middle-America Whites versus Low-Income White. However, mortality was lower among Middle-America Blacks (-23 %; p = 0.06) and High-Risk Urban Blacks (-24 %; p = 0.01) compared to Southern Low-Income Rural Blacks. Compared to Middle-American Whites, mortality was higher among Middle-America Blacks (+39 %; p < 0.001), High-Risk Urban Blacks (+35 %; p < 0.001) and Southern Low-Income Rural Blacks (+85 %; p < 0.001).
Accounting for cardiovascular risk unmasked a greater disparity in mortality between Blacks and Whites and among Southern Rural Blacks compared to Middle-America Blacks and High-Risk Urban Blacks.
我们评估了由中风和心血管疾病的弗雷明汉风险评分（FSRS 和 FCRS）评估的心血管危险因素差异是否导致美国不同种族和地区人群全因死亡率的差异。
为 30086 名 REGARDS 参与者计算了特定于种族和地区的 FSRS 和 FCRS 评分，这些参与者于 2003 年 1 月至 2007 年 10 月期间招募。他们被分为“八大美国”的六个区域，然后在调整种族和性别后进行比较。在调整年龄和性别后，首先估计了各个区域之间的全因死亡率的 Kaplan-Meier 曲线和风险比，然后根据风险评分进行了调整。
在调整年龄、性别、FCRS 和 FSRS 后，中美洲白人与低收入白人之间的死亡率没有差异。然而，与南部低收入农村黑人相比，中美洲黑人（-23%；p=0.06）和高风险城市黑人（-24%；p=0.01）的死亡率较低。与中美洲白人相比，中美洲黑人（+39%；p<0.001）、高风险城市黑人（+35%；p<0.001）和南部低收入农村黑人（+85%；p<0.001）的死亡率更高。
考虑到心血管风险，黑人与白人之间以及与南部农村黑人与中美洲黑人之间的死亡率差异更大。
