Racial Disparities in Heart Disease Mortality in the 50 Largest U.S. Cities
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Heart disease is not only the leading cause of death in the U.S. but also the main contributor to racial disparities in life expectancy. Despite this, heart disease mortality rates and racial disparities in these rates are not readily available at the city level where they can be the most quickly and effectively addressed. We calculated age-adjusted heart disease mortality rates and corresponding racial rate ratios (RRs) and rate differences (RDs) for the non-Hispanic Black (Black) and non-Hispanic White (White) populations for the years 1990–1994 and 2005–2009 for the U.S. and the 50 largest cities therein. We then examined relationships between the disparities and city-level population indicators. Nationally, mortality rates were significantly higher among Blacks than Whites at both time periods. Larger improvements in rates for Whites compared to Blacks resulted in a significant increase in disparities over the 20-year period for 11 cities. There were 19,448 excess Black deaths in the U.S. annually. City-level income inequality, as well as the overall city and White median household income, contributed to these disparities. By identifying city-specific disparities and trends, health care providers, public health agencies, and researchers can target the areas with the most need and can look at cities without disparities for clues on how to best advance health equity in heart disease morbidity and mortality.
KeywordsDisparities Heart disease Mortality Epidemiology
We thank Adelina Huo for her assistance with developing the figure for this paper.
Benjamins and Hunt conceptualized the study. Benjamins and Hunter were the main authors of the manuscript. Hirschtick, Hunt, and Hughes developed the statistical procedures, performed the analyses, and wrote up the results. All authors contributed to the interpretation of findings.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Animal and Human Studies
No animal or human studies were carried out by the authors for this article.
- 3.Kochanek KD, Arias E, Anderson RN. How did cause of death contribute to racial differences in life expectancy in the United States in 2010? NCHS Data Brief. 2013;125:1–8.Google Scholar
- 4.Barrett-Connor E. Gender differences and disparities in all-cause and coronary heart disease mortality: epidemiological aspects. Best practice & research. Clinical endocrinology & metabolism. 2013;27(4):481–500.Google Scholar
- 6.Centers for Disease Control and Prevention. Deaths: final data for 2013. National vital statistics report; vol 64 no. 2. Hyattsville, MD: National Center for Health Statistics. 2013.Google Scholar
- 10.National Institutes of Health, National Heart, Lung, and Blood Institute (2012). Morbidity & mortality: 2012 chart book on cardiovascular, lung, and blood diseases. http://www.nhlbi.nih.gov/files/docs/research/2012_ChartBook.pdf. Accessed December 9, 2015.
- 12.Centers for Disease Control and Prevention. Disparities in premature deaths from heart disease—50 states and the District of Columbia, 2001. MMWR Morb Mortal Wkly Rep. 2004;53(6):121–5.Google Scholar
- 16.Breitfellner G, Neuhold R. Regional variations in mortality from diseases of the heart. Stat Bull Metrop Insur Co. 1984;65(3):8–14.Google Scholar
- 20.Casper ML, Barnett E, Halverson JA, et al. Women and heart disease: an atlas of racial and ethnic disparities in mortality. 2nd ed. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention; 2000.Google Scholar
- 21.National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. Heart disease death rates, total population ages 35+. http://www.cdc.gov/dhdsp/maps/national_maps/hd_all.htm. Accessed December 5, 2015.
- 22.Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 (2010).Google Scholar
- 23.Foraker RE, Rose KM, Kucharska-Newton AM, Ni H, Suchindran CM, Whitsel EA. Variation in rates of fatal coronary heart disease by neighborhood socioeconomic status: the atherosclerosis risk in communities surveillance (1992-2002). Ann Epidemiol. 2011;21(8):580–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Pearson TA, Palaniappan LP, Artinian NT, et al. American Heart Association guide for improving cardiovascular health at the community level, 2013 update: a scientific statement for public health practitioners, healthcare providers, and health policy makers. Circulation. 2013;127(16):1730–53.CrossRefPubMedGoogle Scholar
- 25.The Guide to Community Preventive Services. The community guide—cardiovascular disease prevention and control. 2016.Google Scholar
- 26.Smith SC, Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 2011;58(23):2432–46.CrossRefPubMedGoogle Scholar
- 27.National Center for Health Statistics. Mortality–all county (micro-data) (1990–2009), as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.Google Scholar
- 28.Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People 2010 Stat Notes. 2001 (20):1–10.Google Scholar
- 29.Centers for Disease Control and Prevention. A guide to state implementation of ICD-10 for mortality part II: applying comparability ratios. Washington, DC: National Center for Health Statistics; 2000.Google Scholar
- 30.Top 50 Cities in the U.S. by Population and Rank. http://www.infoplease.com/ipa/A0763098.html. Accessed December 5, 2015.
- 31.Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research: principles and quantitative methods. USA: Wiley; 1982.Google Scholar
- 32.SAS Institute Inc. SAS: version 9.2 for windows. Cary (NC): SAS Institute Inc.; 2002-2008.Google Scholar
- 35.U.S. Census Bureau. 2005-2007 American community survey. http://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t#. Accessed June 1, 2015.
- 36.U.S. Census Bureau. Residential segregation data: exposure and isolation indices based on 2005-2009 ACS census data. http://www.s4.brown.edu/us2010/Data/data.htm. Accessed June 1, 2015.
- 37.U.S. Census Bureau. 2008-2010 American community survey http://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t#. Accessed June 1, 2015.
- 41.National Center for Health Statistics. Health, United States, 2010. Hyattsville, MD: With Special Feature on Death and Dying; 2011.Google Scholar
- 45.Susan G. Komen. 2014. Fact sheet: empowering African American women for breast cancer access. Retrieved from http://www.komenlacounty.org/assets/press-materials/aai/aai-fact-sheet.pdf.
- 47.U.S. Department of Health and Human Services. Preventive services covered under the Affordable Care Act. http://www.hhs.gov/healthcare/facts-and-features/fact-sheets/preventive-servicescovered-under-aca/index.html. Accessed June 1, 2015.
- 52.Barnett E, Braham VE, Casper ML, Elmes G, Halverson JA. Men and heart disease: an atlas of racial and ethnic disparities in mortality. 1st ed. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention; 2007.Google Scholar
- 53.Assari S, Sonnega A. Racial differences in the predictive role of high depressive symptoms on incident heart disease over 18 years: results from the health and retirement study. Res Cardiovasc Med. 2016: e34767. doi: 10.5812/cardiovascmed.34767.