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US Mortality: Influence of Race, Geography and Cardiovascular Risk Among Participants in the Population-Based REGARDS Cohort

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Objectives

We evaluated whether differences in cardiovascular risk factors, as assessed by the Framingham risk scores for stroke and cardiovascular disease (FSRS and FCRS), contributed to disparities in all-cause mortality across race and regional strata of USA.

Design

Race-region-specific FSRS and FCRS scores were computed for 30,086 REGARDS participants who were recruited between January 2003 and October 2007. They were divided across six regions of the “Eight Americas” and then compared after adjusting for race and sex. Kaplan-Meier curves and hazard ratios for all-cause mortality were estimated between regions, first adjusted for age and sex, and then for the risk scores.

Results

After adjustment for age, sex, FCRS, and FSRS, there was no difference in mortality among Middle-America Whites versus Low-Income White. However, mortality was lower among Middle-America Blacks (−23 %; p = 0.06) and High-Risk Urban Blacks (−24 %; p = 0.01) compared to Southern Low-Income Rural Blacks. Compared to Middle-American Whites, mortality was higher among Middle-America Blacks (+39 %; p < 0.001), High-Risk Urban Blacks (+35 %; p < 0.001) and Southern Low-Income Rural Blacks (+85 %; p < 0.001).

Conclusion

Accounting for cardiovascular risk unmasked a greater disparity in mortality between Blacks and Whites and among Southern Rural Blacks compared to Middle-America Blacks and High-Risk Urban Blacks.

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Author information

Authors and Affiliations

  1. Department of Neurology, University of Alabama at Birmingham, 1235 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35294-0021, USA

    Nita A. Limdi

  2. Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Virginia J. Howard

  3. Department of Community and Rural Medicine, University of Alabama, Tuscaloosa, AL, USA

    John Higginbotham

  4. Department of Information Systems, Statistics, and Management Science University of Alabama, Tuscaloosa, AL, USA

    Jason Parton

  5. Departments of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Monika M. Safford

  6. Departments of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA

    George Howard

Authors
  1. Nita A. Limdi
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  2. Virginia J. Howard
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  3. John Higginbotham
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  4. Jason Parton
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  5. Monika M. Safford
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  6. George Howard
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Corresponding author

Correspondence to Nita A. Limdi.

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Funding Support

This REGARDS research project is supported by a cooperative agreement from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service (grant U01 NS041588). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. Additional support was received from National Heart Lung and Blood Institute (grant RO1HL092173, NAL, R01HL080477, K24HL111154, MS). The authors thank the other investigators and the staff of the REGARDS study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at http://www.regardsstudy.org

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Key messages

1. Our assessment of disparities in mortality in the population-based REGARDS cohort shows that despite the varied distribution of CVD risk factors and FSRS and FCRS across race–county regions, mortality differences among White participants were not significantly influenced by CVD risk in our study.

2. However, among Blacks, accounting for CVD risk unmasked a greater disparity with Southern Low-Income Rural Blacks experiencing higher mortality compared to the other two Black subgroups and Whites.

3. This highlights the need for interventions that are targeted and culturally concordant to improve mortality especially among Blacks, and more specifically, among Southern Low-Income Blacks.

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Limdi, N.A., Howard, V.J., Higginbotham, J. et al. US Mortality: Influence of Race, Geography and Cardiovascular Risk Among Participants in the Population-Based REGARDS Cohort. J. Racial and Ethnic Health Disparities 3, 599–607 (2016). https://doi.org/10.1007/s40615-015-0179-7

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  • DOI: https://doi.org/10.1007/s40615-015-0179-7

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