Key result
African American veterans had 30% lower all-cause mortality (P<.001) and 29% lower CHD incidence (P<.001) than White veterans, but higher ischemic stroke risk (aHR 1.16; 95% CI 1.13-1.18).
Why the study?
Does African American race affect all-cause mortality, incident CHD, and ischemic stroke compared to White race in patients receiving care in the Veterans Health Administration?
Cohort (n=3,072,966)
Yes
Does African American race affect all-cause mortality, incident CHD, and ischemic stroke compared to White race in patients receiving care in the Veterans Health Administration?
In an egalitarian health care system like the VA, younger African Americans with normal kidney function had lower all-cause mortality and CHD incidence compared to White patients, though stroke risk increased in older age.
Answers are grounded in this paper and cite their sources.
Paradoxical risks in African American veterans warrant caution in risk models; leaves open contributors beyond healthcare access.
Background: In the general population, compared wtih their White peers, African Americans suffer premature all-cause and cardiovascular (CV) deaths, attributed in part to reduced access to care and lower socioeconomic status. Prior reports indicated younger (aged 35 to 44 years) African Americans had a signficantly greater age-adjusted risk of death. Recent studies suggest that in a more egalitarian health care structure than typical United States (US) health care structures, African Americans may have similar or even better CV outcomes, but the impact of age is less well-known. Methods: We examined age stratified all-cause mortality, and incident coronary heart disease (CHD) and ischemic stroke in 3,072,966 patients (547,441 African American and 2,525,525 White) with an estimated glomerular filtration rate (eGFR)>60 mL/min/1.73m2 receiving care from the US Veterans Health Administration. Outcomes were examined in Cox models adjusted for demographics, comorbidities, kidney function, blood pressure, socioeconomics and indicators of the quality of health care delivery. Results: African Americans had an overall 30% lower all-cause mortality (P<.001) and 29% lower incidence of CHD (P<.001) and higher incidence of ischemic stroke (aHR, 95%CI: 1.16, 1.13-1.18, P<.001). The lower rates of mortality and CHD were strongest in younger African Americans and attenuated across patients aged >70 years. Stroke rates did not differ by race in persons aged <70 years. Conclusions: Among patients with normal eGFR and receiving care in the Veterans Health Administration, younger African Americans had lower all-cause mortality and incidence of CHD and similar rates of stroke, independent of demographic, comorbidity and socioeconomic differences. The lower all-cause mortality persisted but attenuated with increasing age and the lower incidence of CHD ended at aged ≥80 years. The higher incidence of ischemic stroke in African Americans was driven by increasing risk in patients aged ≥70 years suggesting that the improved cardiovascular outcomes were most dramatic for younger African Americans. Ethn Dis. 2016;26(3):305-314; doi:10.18865/ed.26.3.305
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Norris et al. (2016) conducted a cohort in Normal estimated glomerular filtration rate (eGFR) (n=3,072,966). African American race vs. White race was evaluated on All-cause mortality, incident coronary heart disease (CHD), and ischemic stroke (aHR 1.16 (for ischemic stroke), 95% CI 1.13-1.18, p=<.001). African American veterans had 30% lower all-cause mortality (P<.001) and 29% lower CHD incidence (P<.001) than White veterans, but higher ischemic stroke risk (aHR 1.16; 95% CI 1.13-1.18).
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