Coronary heart disease incidence and survival in African-American women and men. The NHANES I Epidemiologic Follow-up Study.
BACKGROUND
Relatively few data are available on risk for or survival with coronary heart disease in African-American persons.


OBJECTIVE
To determine whether incidence of coronary heart disease, rate of survival with the disease, and rate of coronary surgery differ between ethnic groups.


METHODS
Prospective cohort study.


METHODS
United States.


METHODS
Persons who responded to the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study. Included in this analysis were 11406 white persons and African-American persons aged 25 to 74 years who had no history of coronary heart disease. Average follow-up for survivors was 19 years (maximum, 22 years).


METHODS
Incident coronary heart disease.


RESULTS
Compared with that in white persons, the age-adjusted risk for coronary heart disease was higher in African-American women aged 25 to 54 years (relative risk, 1.76 [95% CI, 1.36 to 2.29]) but was lower in African-American men within each age subgroup. The age-adjusted risk was lower in African-American men for all ages combined (25 to 74 years) (relative risk, 0.78 [CI, 0.65 to 0.93] for coronary heart disease and 0.62 [CI, 0.42 to 0.92] for acute myocardial infarction). The higher rate in African-American women aged 25 to 54 years could be explained statistically by the higher risk factor levels in these women. Ethnic groups did not significantly differ in survival after the first hospitalization for coronary heart disease. However, the incidence of coronary procedures after hospitalization for coronary heart disease was markedly lower in African-American persons than in white persons (age- and sex-adjusted relative risk, 0.40 [CI, 0.16 to 0.99]).


CONCLUSIONS
Total incidence of coronary heart disease is higher in African-American women aged 25 to 54 years than in white women of the same ages and is lower in African-American men aged 25 to 74 years than in white men of the same ages.
Gillum
R F
RF
Office of Analysis, Epidemiology, and Health Promotion, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA.
Mussolino
M E
ME
Madans
J H
JH
D000328:Adult; D000368:Aged; D044383:Black People; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D001741:Black or African American