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Hazard ratio for CVD mortality for Blacks versus Whites no longer significant after adjustment for social risk factors.

The Black-White disparity in cardiovascular disease (CVD) mortality is attenuated after adjustment for behavioral and metabolic risk factors and is no longer significant after adjustment for social risk factors, according to a study published online Aug. 15 in the Annals of Internal Medicine.

Jiang He, M.D., Ph.D., from the Tulane University School of Public Health and Tropical Medicine in New Orleans, and colleagues examined the degree to which social, behavioral, and metabolic risk factors are associated with CVD mortality and their impact on racial differences in CVD mortality in a prospective cohort study that included a nationally representative sample of 50,808 persons aged 20 years and older.

The researchers confirmed 2,589 CVD deaths over an average of 9.4 years of follow-up. The age- and sex-standardized rates of CVD mortality were 484.7, 384.5, 292.4, and 255.1 deaths per 100,000 person-years in Black, White, Hispanic, and other race groups, respectively. After adjustment for all measured risk factors simultaneously, several social, behavioral, and metabolic risk factors were associated with significantly elevated risk for CVD death. The hazard ratios for CVD mortality for Black versus White participants were attenuated from 1.54 (95 percent confidence interval, 1.34 to 1.77) to 1.34 (1.16 to 1.55), 1.31 (1.15 to 1.50), and 1.04 (0.90 to 1.21), respectively, after adjustment for metabolic, behavioral, and social risk factors separately.

“Future research is warranted to understand the underlying mechanisms of social determinants of health on CVD mortality and develop novel interventions for reducing CVD mortality in populations, especially in Black persons,” the authors write.

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