Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine; Tulane University Translational Science Institute; and Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana (J.H.).
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, and Tulane University Translational Science Institute, New Orleans, Louisiana (J.D.B., S.G., L.T., H.H., A.H.A., K.S.D., K.T.M.).
Ann Intern Med. 2023 Sep;176(9):1200-1208. doi: 10.7326/M23-0507. Epub 2023 Aug 15.
Cardiovascular disease (CVD) mortality is persistently higher in the Black population than in other racial and ethnic groups in the United States.
To examine the degree to which social, behavioral, and metabolic risk factors are associated with CVD mortality and the extent to which racial differences in CVD mortality persist after these factors are accounted for.
Prospective cohort study.
NHANES (National Health and Nutrition Examination Survey) 1999 to 2018.
A nationally representative sample of 50 808 persons aged 20 years or older.
Data on social, behavioral, and metabolic factors were collected in each NHANES survey using standard methods. Deaths from CVD were ascertained from linkage to the National Death Index with follow-up through 2019.
Over an average of 9.4 years of follow-up, 2589 CVD deaths were confirmed. The age- and sex-standardized rates of CVD mortality were 484.7 deaths per 100 000 person-years in Black participants, 384.5 deaths per 100 000 person-years in White participants, 292.4 deaths per 100 000 person-years in Hispanic participants, and 255.1 deaths per 100 000 person-years in other race groups. In a multiple Cox regression analysis adjusted for all measured risk factors simultaneously, several social (unemployment, low family income, food insecurity, lack of home ownership, and unpartnered status), behavioral (current smoking, lack of leisure-time physical activity, and sleep <6 or >8 h/d), and metabolic (obesity, hypertension, and diabetes) risk factors were associated with a significantly higher risk for CVD death. After adjustment for these metabolic, behavioral, and social risk factors separately, hazard ratios of CVD mortality for Black compared with White participants were attenuated from 1.54 (95% CI, 1.34 to 1.77) to 1.34 (CI, 1.16 to 1.55), 1.31 (CI, 1.15 to 1.50), and 1.04 (CI, 0.90 to 1.21), respectively.
Causal contributions of social, behavioral, and metabolic risk factors to racial and ethnic disparities in CVD mortality could not be established.
The Black-White difference in CVD mortality diminished after adjustment for behavioral and metabolic risk factors and completely dissipated with adjustment for social determinants of health in the U.S. population.
National Institutes of Health.
在美国，心血管疾病（CVD）的死亡率在黑人中持续高于其他种族和族裔群体。
研究社会、行为和代谢风险因素与 CVD 死亡率的关联程度，以及在考虑这些因素后，CVD 死亡率的种族差异持续存在的程度。
前瞻性队列研究。
NHANES（国家健康和营养检查调查）1999 年至 2018 年。
一项全国代表性样本，共 50808 名年龄在 20 岁或以上的成年人。
使用标准方法在每个 NHANES 调查中收集社会、行为和代谢因素的数据。通过与国家死亡指数链接并在 2019 年之前进行随访来确定 CVD 死亡。
在平均 9.4 年的随访中，确认了 2589 例 CVD 死亡。黑人参与者的 CVD 死亡率为每 10 万人年 484.7 例，白人参与者为每 10 万人年 384.5 例，西班牙裔参与者为每 10 万人年 292.4 例，其他种族群体为每 10 万人年 255.1 例。在同时调整所有测量风险因素的多 Cox 回归分析中，几种社会（失业、低家庭收入、粮食不安全、无住房所有权和未婚）、行为（当前吸烟、缺乏休闲时间体育活动和睡眠 <6 或 >8 h/d）和代谢（肥胖、高血压和糖尿病）风险因素与 CVD 死亡风险显著增加相关。在单独调整这些代谢、行为和社会风险因素后，与白人参与者相比，黑人参与者的 CVD 死亡率的危险比从 1.54（95%CI，1.34 至 1.77）降至 1.34（CI，1.16 至 1.55）、1.31（CI，1.15 至 1.50）和 1.04（CI，0.90 至 1.21）。
社会、行为和代谢风险因素对 CVD 死亡率的种族和民族差异的因果贡献无法确定。
在美国人群中，调整行为和代谢风险因素后，黑人和白人之间的 CVD 死亡率差异缩小，而调整健康的社会决定因素后则完全消除。
美国国立卫生研究院。
