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Coronary Heart Disease Incidence and Survival in African-American Women and Men: The NHANES I Epidemiologic Follow-up Study

Richard F. Gillum, MD; Michael E. Mussolino, MA; and Jennifer H. Madans, PhD
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From the Centers for Disease Control and Prevention, Hyattsville, Maryland. Acknowledgments: The NHANES I Epidemiologic Follow-up Study has been developed and funded by the National Center for Health Statistics; National Institute on Aging; National Cancer Institute; National Institute of Child Health and Human Development; National Heart, Lung, and Blood Institute; National Institute of Mental Health; National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Arthritis and Musculoskeletal and Skin Diseases; National Institute of Allergy and Infectious Diseases; National Institute of Neurological and Communicative Disorders and Stroke; Centers for Disease Control and Prevention; and U.S. Department of Agriculture. The field work was conducted by Westat, Inc. (contract numbers 233-80-2049 and 282-84-2111). Requests for Reprints: Richard F. Gillum, MD, Office of Analysis, Epidemiology, and Health Promotion, Centers for Disease Control and Prevention, National Center for Health Statistics, 6525 Belcrest Road, Room 730, Hyattsville, MD 20782. Current Author Addresses: Dr. Gillum and Mr. Mussolino: Office of Analysis, Epidemiology, and Health Promotion, Centers for Disease Control and Prevention, National Center for Health Statistics, 6525 Belcrest Road, Room 730, Hyattsville, MD 20782.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;127(2):111-118. doi:10.7326/0003-4819-127-2-199707150-00003
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Background: Relatively few data are available on risk for or survival with coronary heart disease in African-American persons.

Objective: To determine whether incidence of coronary heart disease, rate of survival with the disease, and rate of coronary surgery differ between ethnic groups.

Design: Prospective cohort study.

Setting: United States.

Participants: Persons who responded to the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study. Included in this analysis were 11 406 white persons and African-American persons aged 25 to 74 years who had no history of coronary heart disease. Average follow-up for survivors was 19 years (maximum, 22 years).

Measurements: Incident coronary heart disease.

Results: Compared with that in white persons, the age-adjusted risk for coronary heart disease was higher in African-American women aged 25 to 54 years (relative risk, 1.76 [95% CI, 1.36 to 2.29]) but was lower in African-American men within each age subgroup. The age-adjusted risk was lower in African-American men for all ages combined (25 to 74 years) (relative risk, 0.78 [CI, 0.65 to 0.93] for coronary heart disease and 0.62 [CI, 0.42 to 0.92] for acute myocardial infarction). The higher rate in African-American women aged 25 to 54 years could be explained statistically by the higher risk factor levels in these women. Ethnic groups did not significantly differ in survival after the first hospitalization for coronary heart disease. However, the incidence of coronary procedures after hospitalization for coronary heart disease was markedly lower in African-American persons than in white persons (age- and sex-adjusted relative risk, 0.40 [CI, 0.16 to 0.99]).

Conclusions: Total incidence of coronary heart disease is higher in African-American women aged 25 to 54 years than in white women of the same ages and is lower in African-American men aged 25 to 74 years than in white men of the same ages.

Figures

Grahic Jump Location
Figure 1.
Probability of surviving free of coronary heart disease in women aged 25 to 74 years according to ethnic group and age at baseline.

Solid lines represent African-American persons, and dashed lines represent white persons.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Probability of surviving free of coronary heart disease in men aged 25 to 74 years according to ethnic group and age at baseline.

Solid lines represent African-American persons, and dashed lines represent white persons.

Grahic Jump Location

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