Racial disparity in long-term mortality rate after hospitalization for myocardial infarction: the Atherosclerosis Risk in Communities study

BACKGROUND: The underlying reasons why African American patients have a significantly higher mortality rate than European American patients after a myocardial infarction (MI) remain unclear. This study examined the racial disparity in mortality rates after MI and possible explanatory factors. METHODS: A prospective analysis was conducted within the Atherosclerosis Risk in Communities (ARIC) study, a community-based study of 15,792 middle-aged adults. From 1987 to 1998, 642 patients (471 European American and 171 African American) hospitalized for MI without prior history of MI were identified. Of these 642 patients, 129 (82 European American and 47 African American) died during follow-up. RESULTS: Cox proportional hazard models were used to analyze the racial difference in mortality rate after MI. After adjusting for age and sex, the relative hazard (RH) comparing African American patients to European American patients was 1.80 (95% CI, 1.24-2.61). The RH decreased after adjusting for vascular risk factors (1.29; 95% CI, 0.83-2.00), socioeconomic position (1.31; 95% CI, 0.83-2.09), severity of MI (1.60; 95% CI, 1.05-2.45), and treatment (1.36; 95% CI, 0.92-2.00). In the final model, which included all factors aforementioned, the RH for race was 1.00 (95% CI, 0.56-1.77). CONCLUSIONS: Our findings suggested that vascular risk factors, socioeconomic position, and treatment play major roles in the racial disparity in mortality rate after MI.http://deepblue.lib.umich.edu/bitstream/2027.42/78990/1/DingDiezRoux2003_AmHeartJ.pd

Women's employment status and mortality: the Atherosclerosis Risk in Communities Study

Background: As women's labor force participation in the United States has increased over the past decades, there has been an interest in the potential health effects of employment. To date, however, research findings have been contradictory. Methods: Thus, the aim of this study was to investigate the association between employment status and mortality among 7361 middle-aged African American and white women who participated in the Atherosclerosis Risk in Communities (ARIC) Study. Women were classified as employed or homemakers at the baseline examination (1987–1989) and were followed for approximately 11 years. Proportional hazards regression was used to estimate unadjusted and adjusted hazard ratios. Results: After adjusting for sociodemographic factors and selected risk factors for mortality, employed women had a lower risk of mortality than homemakers (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.49, 0.86). This decreased risk of mortality persisted in additional analyses that excluded those who died within the first 2 years of follow-up or, alternatively, those with a history of coronary heart disease (CHD), stroke, cancer, hypertension, diabetes, or a perception of fair or poor health at baseline. In cause of death-specific analyses, the mortality advantage among employed women persisted for circulatory systemrelated deaths; however, the association for cancer-related deaths was weaker, and the CI included one. Conclusions: As the association between employment status and mortality was not explained by known risk factors for mortality, additional research is needed to identify other potential factors that may help to explain this relationshiphttp://deepblue.lib.umich.edu/bitstream/2027.42/57749/1/Womens Employment in Status and Mortality The Atherosclerosis Risk in Communities Study.pd

Socioeconomic status in the epidemiology and treatment of hypertension. Hypertension

T he main purpose of this article is to amplify the other presentations by reviewing the evidence for the association of socioeconomic status (SES) with the prevalence, prognosis, and efficacy of treatment of hypertension, with primary reference to the Hypertension Detection and Follow-up Program (HDFP). 1 -3 A secondary purpose is to estimate the potential impact of these associations on the natural history and clinical course of hypertension, with the assumption that there exists a causal influence in the social environment as assessed by SES. An association of high blood pressure with SES has been demonstrated in many population studies. This finding was also observed in the screening phase of the HDFP, where a strong monotonic relation of increasing prevalence of hypertension with decreasing educational achievement was reported ( 1 In this screening phase, based on the study of middle-aged adults sampled in 14 communities in 1973-1974, the prevalence of hypertension in blacks was larger than that of whites for each category of educational achievement; however, a gradient of decreasing prevalence of hypertension with increasing educational achievement (until the level where some college education was reached) was present for blacks as well as whites. Due to the nature of a prevalence study, this association does not address the question of possible confounders or antecedent determinants, for example, the age at onset of hypertension and the consequent effects of duration of elevated blood pressure or prior treatment and selective survival. Further, although stratified by nominally similar educational achievement levels, the black-white comparisons are not necessarily controlled for equal or even similar social environmental experiences. In this context, it is more appropriate to consider the black social environmental experience as categorically distinct. The gradient of hypertension prevalence increases from highest to lowest educational level for whites. The prevalence of hypertension is larger for blacks at the highest educational level than it is for whites at the lowest level of educational achievement, and the prevalence of hypertension progressively increases with decreasing levels of educational achievement for blacks. In addition to the prevalence of hypertension associated with educational achievement, the prognostic relations 2 in The 5-year risk of death (age-adjusted percent mortality) was calculated for stratum 1 men aged 40-69 years at entry who were stratified by race and education. The risk of death was greater for each successively lower educational achievement stratum among whites and even greater for blacks wit

Association of education achievement with the pulsatile arterial diameter change of the common carotid artery: The ARIC Study 1987-1992

http://deepblue.lib.umich.edu/bitstream/2027.42/56183/1/Din-Dzietham R, Association of education achievement with the pulsatile arterial diameter change of the common carotid artery The ARIC Study 1987-1992, 2000.pd

Neighborhood environments and coronary heart disease: a multilevel analysis

http://deepblue.lib.umich.edu/bitstream/2027.42/55392/1/Diez Roux 1997 Amer Jrnl Epi Neighborhood Environments and Coronary Heart Disease A Multilevel Analysis.pd

Neighborhood of Residence and Incidence of Coronary Heart Disease

http://deepblue.lib.umich.edu/bitstream/2027.42/55369/1/01NEJMNeighborhood.pd