title: Skin color and mortality risk among men: the Puerto Rico Heart Health Program.
abstract: OBJECTIVE
  To examine the association between skin color and all-cause and cardiovascular disease (CVD)-related mortality risk before and after adjusting for selected characteristics and risk factors, we used data on 5,304 men with information on skin color at Exam 3 of the Puerto Rico Heart Health program (PRHHP), a longitudinal study of the incidence of coronary heart disease in Puerto Rican men.
  
  
  METHODS
  Mortality was ascertained using hospital and physician records, postmortem records, death certificates, and information from the next of kin.
  
  
  RESULTS
  Dark-skinned men exhibited higher age-adjusted mortality rates than light skinned men (10.1 vs. 8.8/10,000 population). There was no association between skin color and all-cause and CVD-related mortality. However, the association between skin color and all-cause mortality varied with area of residence (p for interaction = 0.05). Among men living in urban areas, the risk of all-cause mortality was 28% (95% confidence interval, 1.02-1.61) greater among dark-skinned men than their light-skinned counterparts after adjusting for age, education, BMI, physical activity, and the presence of diabetes. There was no association between skin color and CVD mortality in urban men. Neither all-cause nor CVD mortality was associated with skin color among rural men.
  
  
  CONCLUSIONS
  Our results suggest that skin color may be capturing environmental dynamics that may influence mortality risk among Puerto Rican men.
authors: Mailman School of Public Health, Columbia University, New York, NY 10032, USA. lnb2@columbia.edu
authors: Luisa N
authors: LN
authors: Borrell
authors: Carlos J
authors: CJ
authors: Crespo
authors: Mario R
authors: MR
authors: Garcia-Palmieri
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002423:Cause of Death; D003327:Coronary Disease / Q000208:ethnology / Q000401:mortality*; D003644:Death Certificates; D015438:Health Behavior / Q000208:ethnology; D006630:Hispanic or Latino / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011647:Puerto Rico / Q000453:epidemiology; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data; D012880:Skin Pigmentation; D012959:Socioeconomic Factors; D014504:Urban Health / Q000706:statistics & numerical data