Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago.
USC/UCLA Center on Biodemography and Population Health, Davis School of Gerontology, University of Southern California (USC).
J Gerontol A Biol Sci Med Sci. 2019 Jan 16;74(2):240-246. doi: 10.1093/gerona/gly026.
Blacks experience greater multisystem physiological dysregulation, or cumulative biological risk, which is associated with poor cardiometabolic health and mortality. In this study, we assess race differences in change in risk over 4 years among older whites, blacks, and Hispanics.
We examined race differences in 4-year change in individual biomarkers and a cumulative measure of risk-cardiometabolic risk (CMR)-using data for each respondent from two waves of the Health and Retirement Study's biomarker assessment (n = 5,512). CMR is a count of high-risk cardiovascular and metabolic biomarkers. We estimated mean CMR at baseline and follow-up by race/ethnicity, and used logistic regression to determine whether race differences exist in 4-year transitions between high- and low-risk states for individual biomarkers.
Blacks had higher baseline CMR than whites and Hispanics and experienced an increase in risk over 4 years; conversely, CMR decreased among whites and Hispanics. Blacks were more likely to develop high-risk pulse pressure and high-risk hemoglobin A1c, which contributed to increases in CMR. Whites and Hispanics were more likely to become low-risk on C-reactive protein and high-density lipoprotein cholesterol which contributed to declines in CMR. Race differences in transitions between risk states remained after controlling for social, behavioral, and health care-related factors. However, the racial patterning of these differences was influenced by disease diagnosis and medication use.
We show that the cardiometabolic health of older blacks worsens as they age both absolutely and relative to that of whites and Hispanics because of poor blood pressure control and diabetes prevention.
黑人经历更大的多系统生理失调，或累积的生物风险，这与较差的心脏代谢健康和死亡率有关。在这项研究中，我们评估了在 4 年内，年龄较大的白种人、黑人和西班牙裔之间风险变化的种族差异。
我们使用来自健康和退休研究生物标志物评估两次波的每个受访者的数据，检查了 4 年内个体生物标志物和累积风险的种族差异 - 心血管风险（CMR）- 生物标志物。CMR 是一组高风险心血管和代谢生物标志物。我们根据种族/族裔估计了基线和随访时的平均 CMR，并使用逻辑回归来确定个体生物标志物的高风险和低风险状态之间的 4 年转变是否存在种族差异。
黑人的基线 CMR 高于白人和西班牙裔，并且在 4 年内风险增加；相反，白人和西班牙裔的 CMR 下降。黑人更有可能发展出高风险的脉压和高风险的血红蛋白 A1c，这导致 CMR 增加。白人和西班牙裔更有可能成为 C-反应蛋白和高密度脂蛋白胆固醇的低风险人群，这有助于 CMR 的下降。在控制社会，行为和医疗保健相关因素后，风险状态之间的种族差异仍然存在。然而，这些差异的种族模式受到疾病诊断和药物使用的影响。
我们表明，随着年龄的增长，黑人的心脏代谢健康状况恶化，无论是相对于白人还是西班牙裔，都是由于血压控制不良和糖尿病预防不佳。
