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. 2022 Jul 19;146(3):211-228.
doi: 10.1161/CIRCULATIONAHA.122.060199. Epub 2022 Jul 18.

Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019

Ashley N Kyalwazi  1   2 , Eméfah C Loccoh  3 , LaPrincess C Brewer  4 , Elizabeth O Ofili  5 , Jiaman Xu  1 , Yang Song  1 , Karen E Joynt Maddox  6 , Robert W Yeh  1 , Rishi K Wadhera  1
Affiliations

Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019

Ashley N Kyalwazi et al. Circulation. .

Abstract

Background: Black adults experience a disproportionately higher burden of cardiovascular risk factors and disease in comparison with White adults in the United States. Less is known about how sex-based disparities in cardiovascular mortality between these groups have changed on a national scale over the past 20 years, particularly across geographic determinants of health and residential racial segregation.

Methods: We used CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) to identify Black and White adults age ≥25 years in the United States from 1999 to 2019. We calculated annual age-adjusted cardiovascular mortality rates (per 100 000) for Black and White women and men, as well as absolute rate differences and rate ratios to compare the mortality gap between these groups. We also examined patterns by US census region, rural versus urban residence, and degree of neighborhood segregation.

Results: From 1999 to 2019, age-adjusted mortality rates declined overall for both Black and White adults. There was a decline in age-adjusted cardiovascular mortality among Black (602.1 to 351.8 per 100 000 population) and White women (447.0 to 267.5), and the absolute rate difference (ARD) between these groups decreased over time (1999: ARD, 155.1 [95% CI, 149.9-160.3]; 2019: ARD, 84.3 [95% CI, 81.2-87.4]). These patterns were similar for Black (824.1 to 526.3 per 100 000) and White men (637.5 to 396.0; 1999: ARD, 186.6 [95% CI, 178.6-194.6]; 2019: ARD, 130.3 [95% CI, 125.6-135.0]). Despite this progress, cardiovascular mortality in 2019 was higher for Black women (rate ratio, 1.32 [95% CI, 1.30-1.33])- especially in the younger (age <65 years) subgroup (rate ratio, 2.28 [95% CI, 2.23-2.32])-as well as for Black men (rate ratio, 1.33 [95% CI, 1.32-1.34]), compared with their respective White counterparts. There was regional variation in cardiovascular mortality patterns, and the Black-White gap differed across rural and urban areas. Cardiovascular mortality rates among Black women and men were consistently higher in communities with high levels of racial segregation compared with those with low to moderate levels.

Conclusions: During the past 2 decades, age-adjusted cardiovascular mortality declined significantly for Black and White adults in the United States, as did the absolute difference in death rates between these groups. Despite this progress, Black women and men continue to experience higher cardiovascular mortality rates than their White counterparts.

Keywords: Black adults; White adults; cardiovascular mortality; racial disparities; racial segregation; rural; sex.

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Figures

Figure 1:
Figure 1:. Age-Adjusted Cardiovascular Mortality Rates for Black and White Adults, 1999–2019.
Panel A. Women Panel B: Men Overall age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) are shown from 1999 to 2019 (Panel A). Overall age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) are shown from 1999 to 2019 (Panel B).
Figure 1:
Figure 1:. Age-Adjusted Cardiovascular Mortality Rates for Black and White Adults, 1999–2019.
Panel A. Women Panel B: Men Overall age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) are shown from 1999 to 2019 (Panel A). Overall age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) are shown from 1999 to 2019 (Panel B).
Figure 2.
Figure 2.. Age-Adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and Age, 1999–2019.
Panel A: Younger Women (age <65 Years) Panel B: Older Women (age ≥65 Years) Panel C: Younger Men (age <65 Years) Panel D: Older Men (age ≥65 Years) Age-adjusted cardiovascular mortality rates for younger women, age <65 years (Panel A) and older women, age ≥65 years (Panel B) are also shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for younger men, age <65 years (Panel C) and older men, age ≥65 years (Panel D) are also shown from 1999 to 2019.
Figure 2.
Figure 2.. Age-Adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and Age, 1999–2019.
Panel A: Younger Women (age <65 Years) Panel B: Older Women (age ≥65 Years) Panel C: Younger Men (age <65 Years) Panel D: Older Men (age ≥65 Years) Age-adjusted cardiovascular mortality rates for younger women, age <65 years (Panel A) and older women, age ≥65 years (Panel B) are also shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for younger men, age <65 years (Panel C) and older men, age ≥65 years (Panel D) are also shown from 1999 to 2019.
Figure 2.
Figure 2.. Age-Adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and Age, 1999–2019.
Panel A: Younger Women (age <65 Years) Panel B: Older Women (age ≥65 Years) Panel C: Younger Men (age <65 Years) Panel D: Older Men (age ≥65 Years) Age-adjusted cardiovascular mortality rates for younger women, age <65 years (Panel A) and older women, age ≥65 years (Panel B) are also shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for younger men, age <65 years (Panel C) and older men, age ≥65 years (Panel D) are also shown from 1999 to 2019.
Figure 2.
Figure 2.. Age-Adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and Age, 1999–2019.
Panel A: Younger Women (age <65 Years) Panel B: Older Women (age ≥65 Years) Panel C: Younger Men (age <65 Years) Panel D: Older Men (age ≥65 Years) Age-adjusted cardiovascular mortality rates for younger women, age <65 years (Panel A) and older women, age ≥65 years (Panel B) are also shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for younger men, age <65 years (Panel C) and older men, age ≥65 years (Panel D) are also shown from 1999 to 2019.
Figure 3.
Figure 3.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and U.S. Census Region, 1999–2019.
Panel A. Northeast - Women Panel B. Northeast – Men Panel C. Midwest- Women Panel D. Midwest- Men Panel E. South- Women Panel F. South- Men Panel G. West- Women Panel H. West- Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in the Northeast (Panel A), Midwest (Panel C), South (Panel E), and West (Panel G) are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in the Northeast (Panel B), Midwest (Panel D), South (Panel F), and West (Panel H) are shown from 1999 to 2019.
Figure 3.
Figure 3.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and U.S. Census Region, 1999–2019.
Panel A. Northeast - Women Panel B. Northeast – Men Panel C. Midwest- Women Panel D. Midwest- Men Panel E. South- Women Panel F. South- Men Panel G. West- Women Panel H. West- Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in the Northeast (Panel A), Midwest (Panel C), South (Panel E), and West (Panel G) are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in the Northeast (Panel B), Midwest (Panel D), South (Panel F), and West (Panel H) are shown from 1999 to 2019.
Figure 3.
Figure 3.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and U.S. Census Region, 1999–2019.
Panel A. Northeast - Women Panel B. Northeast – Men Panel C. Midwest- Women Panel D. Midwest- Men Panel E. South- Women Panel F. South- Men Panel G. West- Women Panel H. West- Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in the Northeast (Panel A), Midwest (Panel C), South (Panel E), and West (Panel G) are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in the Northeast (Panel B), Midwest (Panel D), South (Panel F), and West (Panel H) are shown from 1999 to 2019.
Figure 3.
Figure 3.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and U.S. Census Region, 1999–2019.
Panel A. Northeast - Women Panel B. Northeast – Men Panel C. Midwest- Women Panel D. Midwest- Men Panel E. South- Women Panel F. South- Men Panel G. West- Women Panel H. West- Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in the Northeast (Panel A), Midwest (Panel C), South (Panel E), and West (Panel G) are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in the Northeast (Panel B), Midwest (Panel D), South (Panel F), and West (Panel H) are shown from 1999 to 2019.
Figure 3.
Figure 3.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and U.S. Census Region, 1999–2019.
Panel A. Northeast - Women Panel B. Northeast – Men Panel C. Midwest- Women Panel D. Midwest- Men Panel E. South- Women Panel F. South- Men Panel G. West- Women Panel H. West- Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in the Northeast (Panel A), Midwest (Panel C), South (Panel E), and West (Panel G) are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in the Northeast (Panel B), Midwest (Panel D), South (Panel F), and West (Panel H) are shown from 1999 to 2019.
Figure 3.
Figure 3.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and U.S. Census Region, 1999–2019.
Panel A. Northeast - Women Panel B. Northeast – Men Panel C. Midwest- Women Panel D. Midwest- Men Panel E. South- Women Panel F. South- Men Panel G. West- Women Panel H. West- Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in the Northeast (Panel A), Midwest (Panel C), South (Panel E), and West (Panel G) are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in the Northeast (Panel B), Midwest (Panel D), South (Panel F), and West (Panel H) are shown from 1999 to 2019.
Figure 3.
Figure 3.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and U.S. Census Region, 1999–2019.
Panel A. Northeast - Women Panel B. Northeast – Men Panel C. Midwest- Women Panel D. Midwest- Men Panel E. South- Women Panel F. South- Men Panel G. West- Women Panel H. West- Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in the Northeast (Panel A), Midwest (Panel C), South (Panel E), and West (Panel G) are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in the Northeast (Panel B), Midwest (Panel D), South (Panel F), and West (Panel H) are shown from 1999 to 2019.
Figure 3.
Figure 3.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults by Gender and U.S. Census Region, 1999–2019.
Panel A. Northeast - Women Panel B. Northeast – Men Panel C. Midwest- Women Panel D. Midwest- Men Panel E. South- Women Panel F. South- Men Panel G. West- Women Panel H. West- Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in the Northeast (Panel A), Midwest (Panel C), South (Panel E), and West (Panel G) are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in the Northeast (Panel B), Midwest (Panel D), South (Panel F), and West (Panel H) are shown from 1999 to 2019.
Figure 4.
Figure 4.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults in Rural and Urban Areas of the US, 1999–2019.
Panel A. Urban Women Panel B. Urban Men Panel C. Rural Women Panel D. Rural Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in both Urban (Panel A) and Rural (Panel C) areas are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in both Urban (Panel B) and Rural (Panel D) areas are shown from 1999 to 2019.
Figure 4.
Figure 4.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults in Rural and Urban Areas of the US, 1999–2019.
Panel A. Urban Women Panel B. Urban Men Panel C. Rural Women Panel D. Rural Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in both Urban (Panel A) and Rural (Panel C) areas are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in both Urban (Panel B) and Rural (Panel D) areas are shown from 1999 to 2019.
Figure 4.
Figure 4.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults in Rural and Urban Areas of the US, 1999–2019.
Panel A. Urban Women Panel B. Urban Men Panel C. Rural Women Panel D. Rural Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in both Urban (Panel A) and Rural (Panel C) areas are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in both Urban (Panel B) and Rural (Panel D) areas are shown from 1999 to 2019.
Figure 4.
Figure 4.. Age-adjusted Cardiovascular Mortality Rates for Black and White Adults in Rural and Urban Areas of the US, 1999–2019.
Panel A. Urban Women Panel B. Urban Men Panel C. Rural Women Panel D. Rural Men Age-adjusted cardiovascular mortality rates for Black women (blue) and White women (red) in both Urban (Panel A) and Rural (Panel C) areas are shown from 1999 to 2019. Age-adjusted cardiovascular mortality rates for Black men (blue) and White men (red) in both Urban (Panel B) and Rural (Panel D) areas are shown from 1999 to 2019.
Figure 5.
Figure 5.. Age-Adjusted Cardiovascular Mortality Rates for Black Adults in Low to Moderate versus High Areas of Residential Racial Segregation by Gender, 2010–2019.
Panel A. Black Women Panel B. Black Men Age-adjusted cardiovascular mortality rates for Black women living in areas of low to moderate (red) versus high (blue) areas of residential racial segregation from 2010 to 2019 (Panel A), and for Black men living in areas of low to moderate (red) versus high (blue) areas of residential racial segregation from 2010 to 2019 (Panel B).
Figure 5.
Figure 5.. Age-Adjusted Cardiovascular Mortality Rates for Black Adults in Low to Moderate versus High Areas of Residential Racial Segregation by Gender, 2010–2019.
Panel A. Black Women Panel B. Black Men Age-adjusted cardiovascular mortality rates for Black women living in areas of low to moderate (red) versus high (blue) areas of residential racial segregation from 2010 to 2019 (Panel A), and for Black men living in areas of low to moderate (red) versus high (blue) areas of residential racial segregation from 2010 to 2019 (Panel B).
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