Abstract 15829: US Mortality: Influence of Race, Geography and Cardiovascular Risk among Participants in The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Background: Race and region have been used to define disparities in life-expectancy the United States. We evaluated if differences in cardiovascular risk factors, as assessed by the Framingham Stroke Risk Score (FSRS) and the Framingham Coronary Risk Score (FCRS), contributed to disparities in life expectancy in the Eight Americas.
Methods: We divided REGARDS cohort into the 8 Americas as previously defined and computed region-specific FSRS and FSRS scores. Differences between the regions in the average FSRS and FCRS were estimated using a general linear model with adjustment for age and sex, with least squares mean scores estimates for the regions. All cause-mortality was estimated for each region using Kaplan-Meier estimates, with hazard ratios between regions estimated with: 1) adjustment for age and sex, and 2) after further adjustment for the risk scores.
Results: Participants (n=30,239; 41% African American, 55% female; Table 1) were distributed across the six of the eight-Americas regions as Northland low-income rural White (0.45%), Middle American White (51.4%), Low income White in Appalachia and the Mississippi valley (6.7%), Black Middle American (22.7%), South Low Income Rural Black (9.2%) and High Risk Urban Black (9.6%).
There is no difference in mortality for Whites after controlling for FSRS, FCRS risk scores. After adjustment for age, sex and FCRS and FSRS (Table), compared to Blacks in Low Income Rural Southern areas, Blacks in Middle America had 23% lower mortality and Blacks in High Risk Urban areas had a 24% lower mortality.
Conclusion: Mortality differences among White participants are not significantly influenced by cardiovascular risk. Accounting for cardiovascular risk unmasks a greater disparity in mortality among Southern blacks. Further research is needed to determine reasons (e.g., access to care) for the higher relative risk of death among South Low Income Rural Blacks compared to High Risk Urban and Middle America Blacks.
- © 2013 by American Heart Association, Inc.