TY - JOUR
T1 - Age, race and car diovascular outcomes in african American vetera ns
AU - Norris, Keith C.
AU - Mensah, George A.
AU - Boulware, L. Ebony
AU - Lu, Jun L.
AU - Ma, Jennie Z.
AU - Streja, Elani
AU - Molnar, Miklos Z.
AU - Kalantar-Zadeh, Kamyar
AU - Kovesdy, Csaba P.
N1 - Funding Information:
This study was supported by grant R01DK096920 to CPK and KKZ and is the result of work supported with resources and the use of facilities at the Memphis VA Medical Center and the Long Beach VA Medical Center. Support for VA/CMS data is provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004). Dr Norris is supported by National Institutes of Health grants TR000124, MD000182 and AG021684.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background: In the general population, compared wtih their White peers, African Americans suffer premature all-cause and cardiovascular (CV) deaths, attributed in part to reduced access to care and lower socioeconomic status. Prior reports indicated younger (aged 35 to 44 years) African Americans had a signficantly greater age-adjusted risk of death. Recent studies suggest that in a more egalitarian health care structure than typical United States (US) health care structures, African Americans may have similar or even better CV outcomes, but the impact of age is less well-known. Methods: We examined age stratified all-cause mortality, and incident coronary heart disease (CHD) and ischemic stroke in 3,072,966 patients (547,441 African American and 2,525,525 White) with an estimated glomerular filtration rate (EGFR)>60 mL/min/1.73m2 receiving care from the US Veterans Health Administration. Outcomes were examined in Cox models adjusted for demographics, comorbidities, kidney function, blood pressure, socioeconomics and indicators of the quality of health care delivery. Results: African Americans had an overall 30% lower all-cause mortality (P<.001) and 29% lower incidence of CHD (P<.001) and higher incidence of ischemic stroke (aHR, 95%CI: 1.16, 1.13-1.18, P<.001). The lower rates of mortality and CHD were strongest in younger African Americans and attenuated across patients aged ?70 years. Stroke rates did not differ by race in persons aged <70 years. Conclusions: Among patients with normal EGFR and receiving care in the Veterans Health Administration, younger African Americans had lower all-cause mortality and incidence of CHD and similar rates of stroke, independent of demographic, comorbidity and socioeconomic differences. The lower all-cause mortality persisted but attenuated with increasing age and the lower incidence of CHD ended at aged ?80 years. The higher incidence of ischemic stroke in African Americans was driven by increasing risk in patients aged ?70 years suggesting that the improved cardiovascular outcomes were most dramatic for younger African Americans.
AB - Background: In the general population, compared wtih their White peers, African Americans suffer premature all-cause and cardiovascular (CV) deaths, attributed in part to reduced access to care and lower socioeconomic status. Prior reports indicated younger (aged 35 to 44 years) African Americans had a signficantly greater age-adjusted risk of death. Recent studies suggest that in a more egalitarian health care structure than typical United States (US) health care structures, African Americans may have similar or even better CV outcomes, but the impact of age is less well-known. Methods: We examined age stratified all-cause mortality, and incident coronary heart disease (CHD) and ischemic stroke in 3,072,966 patients (547,441 African American and 2,525,525 White) with an estimated glomerular filtration rate (EGFR)>60 mL/min/1.73m2 receiving care from the US Veterans Health Administration. Outcomes were examined in Cox models adjusted for demographics, comorbidities, kidney function, blood pressure, socioeconomics and indicators of the quality of health care delivery. Results: African Americans had an overall 30% lower all-cause mortality (P<.001) and 29% lower incidence of CHD (P<.001) and higher incidence of ischemic stroke (aHR, 95%CI: 1.16, 1.13-1.18, P<.001). The lower rates of mortality and CHD were strongest in younger African Americans and attenuated across patients aged ?70 years. Stroke rates did not differ by race in persons aged <70 years. Conclusions: Among patients with normal EGFR and receiving care in the Veterans Health Administration, younger African Americans had lower all-cause mortality and incidence of CHD and similar rates of stroke, independent of demographic, comorbidity and socioeconomic differences. The lower all-cause mortality persisted but attenuated with increasing age and the lower incidence of CHD ended at aged ?80 years. The higher incidence of ischemic stroke in African Americans was driven by increasing risk in patients aged ?70 years suggesting that the improved cardiovascular outcomes were most dramatic for younger African Americans.
KW - African American
KW - Age
KW - Chronic Kidney Disease
KW - Coronary Heart Disease
KW - Incidence
KW - Mortality
KW - Race
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=84979702292&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84979702292&partnerID=8YFLogxK
U2 - 10.18865/ed.26.3.305
DO - 10.18865/ed.26.3.305
M3 - Article
C2 - 27440969
AN - SCOPUS:84979702292
SN - 1049-510X
VL - 26
SP - 305
EP - 314
JO - Ethnicity and Disease
JF - Ethnicity and Disease
IS - 3
ER -