title: Does the association between depressive symptoms and cardiovascular mortality risk vary by race? Evidence from the Health and Retirement Study.
abstract: OBJECTIVE
  To test whether the association between depressive symptoms and cardiovascular disease (CVD) mortality is stronger among Blacks than Whites.
  
  
  METHODS
  2,638 Black and 15,132 White participants from a prospective, observational study of community-dwelling Health and Retirement Study participants (a nationally representative sample of U.S. adults aged > or = 50). Average follow-up was 9.2 years.
  
  
  METHODS
  Cause of death (per ICD codes) and month of death were identified from National Death Index linkages.
  
  
  METHODS
  The associations between elevated depressive symptoms and mortality from stroke, ischemic heart disease (IHD), or total CVD were assessed using Cox proportional hazards models to estimate adjusted hazard ratios (HRs). We used interaction terms for race by depressive symptoms to assess effect modification (multiplicative scale).
  
  
  RESULTS
  For both Whites and Blacks, depressive symptoms were associated with a significantly elevated hazard of total CVD mortality (Whites: HR=1.46; 95% CI: 1.33, 1.61; Blacks: HR=1.42, 95% CI: 1.10, 1.83). Adjusting for health and socioeconomic covariates, Whites with elevated depressive symptoms had a 13% excess hazard of CVD mortality (HR=1.13, 95% CI: 1.03, 1.25) compared to Whites without elevated depressive symptoms. The HR in Blacks was similar, although the confidence interval included the null (HR=1.12, 95% CI: .86, 1.46). The hazard associated with elevated depressive symptoms did not differ significantly by race (P>.15 for all comparisons). Patterns were similar in analyses restricted to respondents age > or =65.
  
  
  CONCLUSIONS
  Clinicians should consider the depressive state of either Black or White patients as a potential CVD mortality risk factor.
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Capistrant
authors.forename: Paola
authors.initials: P
authors.lastname: Gilsanz
authors.forename: J Robin
authors.initials: JR
authors.lastname: Moon
authors.forename: Anna
authors.initials: A
authors.lastname: Kosheleva
authors.forename: Kristen K
authors.initials: KK
authors.lastname: Patton
authors.forename: M Maria
authors.initials: MM
authors.lastname: Glymour
mesh_terms: D001741:Black or African American; D000368:Aged; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000401:mortality; D003863:Depression / Q000208:ethnology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D044465:White People