title: Evidence of increasing coronary heart disease mortality among black men of lower social class.
abstract: OBJECTIVE
  Few data are available to examine coronary heart disease (CHD) mortality trends by social class in the United States, in contrast to ample data and well-documented social class disparities in CHD in Europe. In addition, previous analyses of U.S. national data indicated that the rate of decline in CHD mortality slowed substantially for blacks in the 1980s. Using a recently published method for calculating mortality rates by social class, we examined trends in CHD mortality for black men and white men aged 35-54 in North Carolina from 1984 to 1993.
  
  
  METHODS
  Men were assigned to one of four social classes: primary white collar (I), secondary white collar (II), primary blue collar (III), or secondary blue collar (IV), based on usual occupation as recorded on the death certificate. Population denominators for each social class were constructed using data from census Public Use Microdata Sample files. Average annual percent change in mortality rates for each race-social class group was derived from linear regression of the log-transformed age-adjusted rates.
  
  
  RESULTS
  For black men, CHD mortality increased by 18% in social class II, by 2% in social class III, and by 6% in social class IV over the 10-year study period. In contrast, CHD mortality decreased by 33% for black men in social class I (the highest class). CHD mortality declined for all white men, with the greatest decline in social class I and the least decline in social class IV.
  
  
  CONCLUSIONS
  These results suggest that CHD prevention efforts have not benefited black men of lower social class, and that public health programs need to be targeted to these men.
authors.affiliation: Department of Community Medicine, West Virginia University, Morgantown 26506-9005, USA. ebarnett@wvu.edu
authors.forename: E
authors.initials: E
authors.lastname: Barnett
authors.forename: D L
authors.initials: DL
authors.lastname: Armstrong
authors.forename: M L
authors.initials: ML
authors.lastname: Casper
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011203:Poverty / Q000208:ethnology / Q000706:statistics & numerical data*; D012923:Social Class; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data