title: Higher cardiovascular disease prevalence and mortality among younger blacks compared to whites.
abstract: BACKGROUND
  Blacks have higher rates of cardiovascular disease than whites. The age at which these differential rates emerge has not been fully examined.
  
  
  OBJECTIVE
  We examined cardiovascular disease prevalence and mortality among black and white adults across the adult age spectrum and explored potential mediators of these differential disease prevalence rates.
  
  
  METHODS
  We conducted a cross-sectional analysis of National Health and Nutrition Examination Survey data from 1999-2006. We estimated age-adjusted and age-specific prevalence ratios (PR) for cardiovascular disease (heart failure, stroke, or myocardial infarction) for blacks versus whites in adults aged 35 years and older and examined potential explanatory factors. From the National Compressed Mortality File 5-year aggregate file of 1999-2003, we determined age-specific cardiovascular disease mortality rates.
  
  
  RESULTS
  In young adulthood, cardiovascular disease prevalence was higher in blacks than whites (35-44 years PR 1.9; 95% confidence interval [CI], 1.1-3.4). The black-white PR decreased with each decade of advancing age (P for trend=.04), leading to a narrowing of the racial gap at older ages (65-74 years PR 1.2; 95% CI, 0.8-1.6; > or =75 years PR 1.0; 95% CI, 0.7-1.4). Clinical and socioeconomic factors mediated some, but not all, of the excess cardiovascular disease prevalence among young to middle-aged blacks. Over a quarter (28%) of all cardiovascular disease deaths among blacks occurred in those aged <65 years, compared with 13% among whites.
  
  
  CONCLUSIONS
  Reducing black/white disparities in cardiovascular disease will require a focus on young and middle-aged blacks.
authors.affiliation: Department of Medicine, University of California, San Francisco, CA, USA. jollys@ccf.org
authors.forename: Stacey
authors.initials: S
authors.lastname: Jolly
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Arpita
authors.initials: A
authors.lastname: Chattopadhyay
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000401:mortality*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities; D006333:Heart Failure / Q000208:ethnology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000401:mortality; D009749:Nutrition Surveys; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology / Q000401:mortality; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*