March 1, 1999American Journal of Public Health109 citationsOpen Access
Evidence for a black-white crossover in all-cause and coronary heart disease mortality in an older population: the North Carolina EPESE.
Key Result
Black adults aged 80 or older had a significantly lower risk of all-cause mortality (HR 0.75; 95% CI 0.62-0.90) and CHD mortality (HR 0.44; 95% CI 0.30-0.66) compared to White adults.
Study Design
Type
Cohort (n=4,136)
Structured PICO
Does Black race compared to White race affect all-cause and coronary heart disease mortality in adults aged 65 and older?
P
Population
4,136 Black and White men and women aged 65 years and older living in North Carolina, followed for mortality from 1986 to 1994.
E
Exposure
Black race (observational exposure)
C
Comparator
White race
O
Outcome
All-cause and cause-specific (coronary heart disease) mortalityhard clinical
In older adults, there is a mortality crossover where Black individuals have higher mortality at ages 65-80 but significantly lower all-cause and CHD mortality after age 80 compared to Whites.
Main Result
Hazard Ratio: 0.75 (95% CI 0.62–0.9)
Abstract
OBJECTIVES: This cohort study evaluated racial differences in mortality among Blacks and Whites 65 years and older. METHODS: A total of 4136 men and women (1875 Whites and 2261 Blacks) living in North Carolina were interviewed in 1986 and followed up for mortality until 1994. Hazard ratios (HRs) for all-cause and cause-specific mortality were calculated, with adjustment for sociodemographic and coronary heart disease (CHD) risk factors. RESULTS: Black persons had higher mortality rates than Whites at young-old age (65-80 years) but had significantly lower mortality rates after age 80. Black persons age 80 or older had a significantly lower risk of all-cause mortality (HR of Blacks vs Whites, 0.75; 95% confidence interval CI = 0.62, 0.90) and of CHD mortality (HR 0.44: 95% CI = 0.30, 0.66). These differences were not observed for other causes of death. CONCLUSIONS: Racial differences in mortality are modified by age. This mortality crossover could be attributed to selective survival of the healthiest oldest Blacks or to other biomedical factors affecting longevity after age 80. Because the crossover was observed for CHD deaths only, age overreporting by Black older persons seems an unlikely explanation of the mortality differences.