Hashemian Maryam, Conners Katherine M, Joo Jungnam, Rafi Rebeka, Henriquez Santos Gretell, Shearer Joseph J, Andrews Marcus R, Powell-Wiley Tiffany M, Shiels Meredith S, Roger Véronique L
Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
JAMA Netw Open. 2025 Mar 3;8(3):e252290. doi: 10.1001/jamanetworkopen.2025.2290.
Washington, District of Colombia (DC), has the largest gap in life expectancy between Black and White populations among major US cities.
To investigate mortality, key modifiable cardiovascular disease (CVD) risk factors, and temporal trends for non-Hispanic Black and non-Hispanic White populations in Washington, DC, from 2000 to 2020.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database for mortality and the Behavioral Risk Factor Surveillance System for the prevalence of risk factors (obesity, hypertension, diabetes, smoking, and hypercholesterolemia) among Black and White populations in Washington, DC, from 2000 to 2020. All analyses were conducted in January 2024.
All-cause and cause-specific, age-adjusted mortality rates per 100 000 person-years, prevalence of risk factors, and corresponding rate ratios (RRs) and 95% CIs comparing Black individuals to White individuals were assessed. Average annual percentage change (AAPC) was examined using joinpoint regression.
Among 102 710 deaths in Washington, DC (51 712 among males [50.3%], 26 100 among individuals aged ≥85 years [25.4%]; 82 308 among Black [80.1%] and 20 402 among White [19.9%] individuals), CVD (33 254 deaths [32.4%]) and cancer (22 677 deaths [22.1%]) accounted for more than half of deaths. All-cause mortality declined between 2000 and 2012 (AAPC, -2.6%; 95% CI, -4.5% to -1.9%), stagnated between 2012 and 2018, and increased between 2018 and 2020 (AAPC, 10.9%; 95% CI. 3.8% to 15.1%). CVD mortality declined between 2000 and 2011 (AAPC, -3.1%; 95% CI, -4.3% to -2.4%) and plateaued thereafter in the Black population, contrasting with the monotonic decline in the White population from 2000 to 2020 (AAPC, -4.7%; 95% CI, -5.3% to -4.1%), for a magnification of disparities from 2000 (RR, 1.5; 95% CI, 1.4 to 1.7) to 2020 (RR, 2.9; 95% CI, 2.5 to 3.3). Cancer mortality decreased from 2000 to 2020 but with a greater magnitude in the White (AAPC, -3.4%; 95% CI, -3.9% to -2.9%) than Black (AAPC, -1.8%; 95% CI, -2.2% to -1.4%) population (RR for 2000, 1.6; 95% CI, 1.4 to 1.8 and RR for 2020, 2.1; 95% CI, 1.8 to 2.4). Risk factors were consistently more prevalent in the Black than White population (eg, hypertension: RR, 2.2; 95% CI, 1.8 to 2.7 in 2001 and 2.3; 95% CI, 1.9-2.6 in 2019). Disparities as assessed by RRs increased for smoking (AAPC, 4.3%; 95% CI, 3.8% to 5.6%), decreased for obesity (AAPC, -1.2%; 95% CI, -1.9% to -0.4%), and remained constant for diabetes, hypercholesterolemia, and hypertension.
In this study, all-cause, age-adjusted mortality was higher in the Black than White population, racial disparities worsened for CVD and cancer, and CVD risk factors were more prevalent in the Black population, underscoring the urgent need for precision public health interventions tailored toward high-risk populations.
在美國主要城市中，華盛頓特區（DC）的黑人和白人人口預期壽命差距最大。
研究2000年至2020年華盛頓特區非西班牙裔黑人和非西班牙裔白人人口的死亡率、主要可改變的心血管疾病（CVD）風險因素及時間趨勢。
設計、背景和參與者：這項橫斷面研究分析了疾病控制和預防中心的廣泛線上流行病學研究數據庫中的死亡率，以及行為風險因素監測系統中華盛頓特區黑人和白人人口中風險因素（肥胖、高血壓、糖尿病、吸煙和高膽固醇血症）的患病率。所有分析於2024年1月進行。
評估了每10萬人年的全因死亡率和特定病因死亡率、風險因素患病率，以及比較黑人與白人的相應率比（RRs）和95%置信區間（CIs）。使用連接點回歸檢驗平均年度百分比變化（AAPC）。
在華盛頓特區的102710例死亡中（男性51712例[50.3%]，85歲及以上個體26100例[25.4%]；黑人82308例[80.1%]，白人20402例[19.9%]），心血管疾病（33254例死亡[32.4%]）和癌症（22677例死亡[22.1%]）占死亡人數一半以上。2000年至2012年間全因死亡率下降（AAPC，-2.6%；95%CI，-4.5%至-1.9%），2012年至2018年間持平，2018年至2020年間上升（AAPC，10.9%；95%CI，3.8%至15.1%）。2000年至2011年間心血管疾病死亡率下降（AAPC，-3.1%；95%CI，-4.3%至-2.4%），其後黑人人口趨於平穩，與2000年至2020年間白人人口的單調下降形成對比（AAPC，-4.7%；95%CI，-5.3%至-4.1%），差距從2000年（RR，1.5；95%CI，1.4至1.7）放大到2020年（RR，2.9；95%CI，2.5至3.3）。2000年至2020年間癌症死亡率下降，但白人下降幅度更大（AAPC，-3.4%；95%CI，-3.9%至-2.9%），黑人下降幅度為（AAPC，-1.8%；95%CI，-2.2%至-1.4%）（2000年RR，1.6；95%CI，1.4至1.8；2020年RR，2.1；95%CI，1.8至2.4）。風險因素在黑人人口中的患病率一直高於白人人口（例如，高血壓：2001年RR，2.2；95%CI，1.8至2.7；2019年RR，2.3；95%CI，1.9至2.6）。RRs評估的差距在吸煙方面增加（AAPC，4.3%；95%CI，3.8%至5.6%），肥胖方面下降（AAPC，-1.2%；95%CI，-1.9%至-0.4%），糖尿病、高膽固醇血症和高血壓方面保持不變。
在本研究中，黑人人口的全因、年齡調整死亡率高於白人人口，心血管疾病和癌症的種族差距惡化，心血管疾病風險因素在黑人人口中更為普遍，這突出表明迫切需要針對高危人群制定精準的公共衛生干預措施。
