Stanford University School of Medicine Stanford CA.
Division of Cardiovascular Medicine and the Cardiovascular Institute Stanford University School of Medicine Stanford CA.
J Am Heart Assoc. 2021 Mar 16;10(6):e018835. doi: 10.1161/JAHA.120.018835. Epub 2021 Mar 3.
Background Persistent racial/ethnic disparities in cardiovascular disease (CVD) mortality are partially explained by healthcare access and socioeconomic, demographic, and behavioral factors. Little is known about the association between race/ethnicity-specific CVD mortality and county-level factors. Methods and Results Using 2017 county-level data, we studied the association between race/ethnicity-specific CVD age-adjusted mortality rate (AAMR) and county-level factors (demographics, census region, socioeconomics, CVD risk factors, and healthcare access). Univariate and multivariable linear regressions were used to estimate the association between these factors; values were used to assess the factors that accounted for the greatest variation in CVD AAMR by race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic/Latinx individuals). There were 659 740 CVD deaths among non-Hispanic White individuals in 2698 counties; 100 475 deaths among non-Hispanic Black individuals in 717 counties; and 49 493 deaths among Hispanic/Latinx individuals across 267 counties. Non-Hispanic Black individuals had the highest mean CVD AAMR (320.04 deaths per 100 000 individuals), whereas Hispanic/Latinx individuals had the lowest (168.42 deaths per 100 000 individuals). The highest CVD AAMRs across all racial/ethnic groups were observed in the South. In unadjusted analyses, the greatest variation () in CVD AAMR was explained by physical inactivity for non-Hispanic White individuals (32.3%), median household income for non-Hispanic Black individuals (24.7%), and population size for Hispanic/Latinx individuals (28.4%). In multivariable regressions using county-level factor categories, the greatest variation in CVD AAMR was explained by CVD risk factors for non-Hispanic White individuals (35.3%), socioeconomic factors for non-Hispanic Black (25.8%), and demographic factors for Hispanic/Latinx individuals (34.9%). Conclusions The associations between race/ethnicity-specific age-adjusted CVD mortality and county-level factors differ significantly. Interventions to reduce disparities may benefit from being designed accordingly.
心血管疾病（CVD）死亡率持续存在的种族/民族差异部分可以通过医疗保健的可及性以及社会经济、人口统计学和行为因素来解释。关于种族/民族特异性 CVD 死亡率与县级因素之间的关联知之甚少。
使用 2017 年县级数据，我们研究了种族/民族特异性 CVD 年龄调整死亡率（AAMR）与县级因素（人口统计学、人口普查区域、社会经济、CVD 风险因素和医疗保健的可及性）之间的关联。使用单变量和多变量线性回归来估计这些因素之间的关联； 值用于评估按种族/民族划分的 CVD AAMR 差异最大的因素（非西班牙裔白人、非西班牙裔黑人以及西班牙裔/拉丁裔个体）。在 2698 个县中，有 659740 名非西班牙裔白人个体死于 CVD；在 717 个县中有 100475 名非西班牙裔黑人个体死于 CVD；在 267 个县中有 49493 名西班牙裔/拉丁裔个体死于 CVD。非西班牙裔黑人个体的 CVD AAMR 平均值最高（每 100000 人中有 320.04 人死亡），而西班牙裔/拉丁裔个体的 CVD AAMR 平均值最低（每 100000 人中有 168.42 人死亡）。所有种族/民族群体的 CVD AAMR 最高的地区是南部。在未经调整的分析中，非西班牙裔白人个体中不运动（32.3%）、非西班牙裔黑人个体中家庭中位数收入（24.7%）和西班牙裔/拉丁裔个体中人口规模（28.4%）对 CVD AAMR 的变化解释最大。在使用县级因素类别的多变量回归中，非西班牙裔白人个体中 CVD 风险因素（35.3%）、非西班牙裔黑人个体中社会经济因素（25.8%）以及西班牙裔/拉丁裔个体中人口统计学因素（34.9%）对 CVD AAMR 的变化解释最大。
种族/民族特异性年龄调整 CVD 死亡率与县级因素之间的关联差异显著。减少差异的干预措施可能会因此而受益。
