Sick Populations and Sick Subpopulations: Reducing Disparities in Cardiovascular Disease Between Blacks and Whites in the United States.
Sick Populations and Sick Subpopulations: Reducing Disparities in Cardiovascular Disease Between Blacks and Whites in the United States.
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DOI：
10.1161/circulationaha.115.018102
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发表时间：
2016-08-09
期刊：
影响因子：
37.8
通讯作者：
Danaei G
中科院分区：
文献类型：
--
作者：
Lu Y;Ezzati M;Rimm EB;Hajifathalian K;Ueda P;Danaei G
在美国，黑人的心血管疾病（CVD）死亡率远高于白人。目前尚不清楚CVD风险和事件在黑人与白人之间的分布以及干预措施如何减少种族差异。我们在美国使用8个队列开发了致死性和致死性和非致死性CVD的风险模型。我们在1999-2012年的国家健康和营养检查调查中使用了6，154名年龄在50-69岁之间的成年人，以估计黑人和白人的风险和事件分布。我们估计了一系列全人群、有针对性和基于风险的干预措施对10年心血管疾病风险和事件发生率的总体影响和差异影响。25%（95%置信区间22-28）的黑人男性和12%（10-14）的黑人女性的致死性CVD风险≥ 6.67%（几乎相当于20%的致死性或非致死性CVD风险），而白色男性和白色女性分别为10%（8-12）和3%（2-4）。这些高风险个体占黑人男性CVD死亡的55%（49-59）和黑人女性CVD死亡的42%（35-46），而白色男性CVD死亡的30%（24-35）和白色女性CVD死亡的18%（13-22）。我们估计，在高危人群中治疗多种危险因素的干预措施可以将CVD死亡率的黑人-白人差异从男性的1，659降至1，244/10万，女性从1，320降至897/10万。黑人和白色男性的致死性和非致死性CVD发生率基本相似。在女性中，更大比例的女性CVD风险≥ 7.5%（白人为30%和19%），针对该组中多种风险因素的干预估计可将CVD率的黑人-白人差异从1，688/10万降至1，197/10万。更大比例的黑人患有致命性心血管疾病的风险很高，并且在心血管疾病死亡中占很大比例。减少多种风险因素的基于风险的干预可以大大降低总体CVD率和CVD死亡率的种族差异。
Cardiovascular disease (CVD) death rates are much higher in blacks than whites in the United States (US). It is unclear how CVD risk and events are distributed among blacks vs. whites and how interventions reduce racial disparities. We developed risk models for fatal and for fatal-and-nonfatal CVD using 8 cohorts in the US. We used 6,154 adults aged 50–69 years in the National Health and Nutrition Examination Survey 1999–2012 to estimate the distributions of risk and events in blacks and whites. We estimated the total as well as disparity impacts of a range of population-wide, targeted and risk-based interventions on 10-year CVD risks and event rates. 25% (95% confidence interval 22–28) of black men and 12% (10–14) of black women were at ≥ 6.67% risk of fatal CVD (almost equivalent to 20% risk of fatal or nonfatal CVD), compared with 10% (8–12) of white men and 3% (2–4) of white women. These high-risk individuals accounted for 55% (49–59) of CVD deaths among black men and 42% (35–46) in black women, compared with 30% (24–35) in white men and 18% (13–22) in white women. We estimated that an intervention that treated multiple risk factors in high-risk individuals could reduce black-white difference in CVD death rate from 1,659 to 1,244 per 100,000 in men and from 1,320 to 897 in women. Rates of fatal-and-nonfatal CVD were generally similar between black and white men. In women, a larger proportion of women were at ≥ 7.5% risk of CVD (30% versus 19% in whites) and an intervention that targeted multiple risk factors among this group was estimated to reduce black-white differences in CVD rates from 1,688 to 1,197 per 100,000. A substantially larger proportion of blacks have a high risk of fatal CVD and bear a large share of CVD deaths. A risk-based intervention that reduces multiple risk factors could substantially reduce overall CVD rates and racial disparities in CVD death rates.