Abstract P107: Differences in Cardiovascular Mortality Risk Among African Americans in the Minnesota Heart Survey, 1985-2015, versus African Americans in the Atherosclerosis Risk in Communities Study (ARIC) Cohort: 1987-2015

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Kristen M George ◽  
Aaron R Folsom ◽  
Lyn M Steffen ◽  
Lynne E Wagenknecht ◽  
Thomas H Mosley
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
African Americans ◽  
Mortality Risk ◽  
Total Mortality ◽  
Mortality Rates ◽  
Death Rates ◽  
Hazard Ratios ◽  
Forsyth County ◽  
Cvd Mortality

Geographic differences in CVD mortality across the U.S. are well-established, but frequently overlooked. ARIC enrolled African Americans (AA) from Jackson, MS and Forsyth County, NC, areas of the Southeast with some of the highest CVD mortality rates, especially among AAs. The Minnesota Heart Survey enrolled AAs from Minnesota where CVD rates are among the lowest. However, it is not known whether AAs in Minnesota also have low rates. Using these two cohorts, we assessed whether CVD-related mortality risk among AAs differs by region. Baseline measures of CVD risk factors for MHS were taken in 1985 from a population based sample of AAs, ages 45 to 65, living in the Minneapolis-St. Paul metropolitan area. These same measures were made at ARIC visit 1 (1987-89) in AA participants of the same age residing in Jackson, MS and Forsyth County, NC. CVD and total mortality were identified using ICD codes for underlying cause of death from State and National Death Index records in both cohorts. We compared MHS and ARIC on CVD death rates using Poisson regression, prevalence of risk factors, and risk factor hazard ratios using Cox regression. After risk factor adjustment, AA men in MHS had a rate of 5.2 (95% CI: 3.2, 7.2) CVD deaths per 1000 person-years compared to 15.1 (95% CI: 13.1, 17.1) for AA men in ARIC. For AA women, MHS had 4.1 (95% CI: 2.7, 5.5) CVD deaths per 1000 person-years versus 10.2 (95% CI: 9.0, 11.4) in ARIC. CVD mortality rates were higher in Jackson than Forsyth County within ARIC. CVD death rates paralleled risk factor prevalence at baseline. Compared to MHS, ARIC had significantly higher total cholesterol (215 vs. 202 mg/dL), albeit higher HDL cholesterol (55 vs. 53 mg/dL), as well as higher anti-hypertensive medication use (41 vs. 30%), diabetes (13 vs. 11%) and BMI (30 vs. 29 kg/m 2 ), while smoking did not differ. Despite risk factor differences, hazard ratios of CVD death associated with each risk factor did not differ between studies even after inclusion of a competing risk of non-CVD death. In conclusion, the CVD death rate was lower in AAs in MHS than in AAs residing in the Southeast in ARIC largely due to lower risk factor levels, since the hazard of CVD death for each risk factor did not differ. Study differences reflect incompletely identified geographic variation that need further exploration, especially in the context of health disparities, but support maintaining low risk as a key to CVD prevention.

scholarly journals Differences in Cardiovascular Mortality Risk among African Americans in the Minnesota Heart Survey: 1985-2015 vs The Atherosclerosis Risk in Communities Study Cohort: 1987-2015

2019 ◽  
Vol 29 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Kristen M. George ◽  
Aaron R. Folsom ◽  
Lyn M. Steffen ◽  
Lynne E. Wagenknecht ◽  
Thomas H. Mosley
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
African Americans ◽  
Population Based ◽  
Study Cohort ◽  
Cvd Risk ◽  
Atherosclerosis Risk In Communities ◽  
Hazard Ratios ◽  
Atherosclerosis Risk ◽  
Cvd Mortality

Geographic differences in cardiovascular disease (CVD) mortality among African Americans (AAs) are well-established, but not well-characterized. Using the Minnesota Heart Survey (MHS) and Atherosclerosis Risk in Communities (ARIC) Study, we aimed to assess whether CVD risk factors drive geographic disparities in CVD mortal­ity among AAs.ARIC risk factors were measured be­tween1987-1989 from a population-based sample of AAs, aged 45 to 64 years, living in Jackson, MS and Forsyth County, NC. Simi­lar measures were made at MHS baseline, 1985, in AAs from Minneapolis-St. Paul, MN. CVD mortality was identified using ICD codes for underlying cause of death. We compared MHS and ARIC on CVD death rates using Poisson regression, risk factor prevalences, and hazard ratios using Cox regression.After CVD risk factor adjustment, AA men in MHS had 3.4 (95% CI: 2.1, 4.7) CVD deaths per 1000 person-years vs 9.9 (95% CI: 8.7, 11.1) in ARIC. AA women in MHS had 2.7 (95% CI: 1.8, 3.6) CVD deaths per 1000 person-years vs 6.7 (95% CI: 6.0, 7.4) in ARIC. A 2-fold higher CVD mortality rate remained in ARIC vs MHS after additional adjustment for education and income. ARIC had higher total cholesterol, hypertension, diabetes, and BMI, as well as less education and income than MHS. Risk factor hazard ratios of CVD death did not differ.The CVD death rate was lower in AAs in Minnesota (MHS) than AAs in the South­east (ARIC). While our findings support maintaining low risk for CVD preven­tion, differences in CVD mortality reflect unidentified geographic variation.Ethn Dis. 2019;29(1):47-52; doi:10.18865/ ed.29.1.47

Peripheral Blood Cytopenia and Subsequent Risk of Cardiovascular Disease and Mortality

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5002-5002
Author(s):  
Radhika Gangaraju ◽  
Insu Koh ◽  
Marguerite R. Irvin ◽  
Leslie A. Lange ◽  
Damon E. Houghton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Mortality Risk ◽  
Peripheral Blood ◽  
Cvd Risk ◽  
Clonal Hematopoiesis ◽  
Chd Risk ◽  
Increased Risk ◽  
Cvd Mortality

INTRODUCTION: African-Americans (blacks) have higher risk of stroke and coronary heart disease (CHD) - collectively referred to here as cardiovascular disease (CVD), than Caucasian-Americans (whites). Though partly explained by traditional cardiovascular risk factors, half of the excess risk in blacks is not explained by known risk factors. Recent data suggest increased risk of CVD and mortality in individuals with clonal hematopoiesis, which often presents as cytopenia. Using peripheral blood cytopenia as a marker of clonal hematopoiesis, we examined the association between cytopenia and risk of CVD and mortality in blacks and whites. METHODS: The REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study enrolled 30,239 US black and white adults between 2003 and 2007 (41% black). Socio-demographics and medical history were obtained by telephone interview, and laboratory studies (including complete blood count [CBC]) and physical exam from an in-home visit at baseline. Participants or their proxies were contacted every 6 months to ascertain CVD events, hospitalizations or deaths, and medical records were reviewed to confirm these events. Cytopenia was defined using thresholds in Table 1 as presence of 2 or more of the following: i) hemoglobin in age-, sex-, and race-specific lowest 5th percentile; ii) white cell count in race-specific lowest 5th percentile; iii) platelet count in lowest 5th percentile, and iv) macrocytosis (MCV >98fL). Participants with pre-baseline history of stroke (for analyses including stroke or CVD mortality) or CHD (for analyses including CHD or CVD mortality) and those with missing CBC were excluded. Cox proportional hazards models were used to calculate hazard ratios (HRs) of incident CVD and mortality associated with cytopenia. Models adjusted for socio-demographics (Model 1), Framingham stroke or CHD risk factors (Model 2), and estimated glomerular filtration rate and C-reactive protein (Model 3) were used. Differences in the association of cytopenia with outcomes by race were tested using cross-product interaction terms, using a p of <0.1 for interaction. RESULTS: The study included 19,544 participants who were followed for a median of ~9 years. There were 798 (4.3% of those at risk) incident stroke cases and 727 (4.3%) incident CHD cases; 1033 (5.3%) died of CVD, and 3933 (20.1%) died of all-causes. Cytopenia was present in 378 (1.9%) participants, ranging from 0.9% to 3.5% in blacks, 1.4 to 3.9% in whites, 1.6 to 3.9% in men, and 0.9 to 1.8% in women, with increasing prevalence by age. There was no association between cytopenia and stroke or CHD risk in any model. However, cytopenia was associated with increased risk of all-cause mortality (HR=1.73, 95%CI: 1.34-2.22), and CVD mortality (HR=1.56, 95% CI: 1.11-2.19) in the extended risk factor Model 3 and also in CVD risk factor adjusted model (Model 2), with little evidence of confounding (Table 2). While the race by cytopenia interaction term was not significant in any model for incident CHD or mortality, the interaction for cytopenia by race for stroke was statistically significant (p-interaction=0.08) in Model 2. The HR of stroke for cytopenia in blacks was 0.86 (95%CI: 0.46-1.61), and for whites was 1.96 (95%CI: 1.0-3.82). CONCLUSION: In this large biracial cohort, cytopenia was associated with increased all-cause and CVD mortality. Cytopenia was a race-specific risk factor for stroke affecting white Americans but not black Americans. With growing knowledge on the role of clonal hematopoiesis in CVD risk and mortality, further work is needed to determine if our phenotype of cytopenia is accurate in classifying clonal hematopoiesis and for determining the mortality risk. Given these findings, assessing clonal hematopoiesis and outcomes related to clonal hematopoiesis in diverse populations is critical to understanding the interactions between somatic mutations in hematopoietic cells and CVD/mortality risk. Disclosures Safford: Amgen: Research Funding.

Abstract P522: Alcohol Consumption and Cardiovascular Mortality After Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Leanne K Küpers ◽  
Anne J de Ruiter ◽  
Maria C Busstra ◽  
Johanna M Geleijnse
Keyword(s):  
Myocardial Infarction ◽  
Alcohol Consumption ◽  
Sex Education ◽  
Mortality Risk ◽  
Reference Group ◽  
Total Mortality ◽  
Dietary Factors ◽  
Hazard Ratios ◽  
Heavy Drinkers ◽  
Cvd Mortality

Background: Little is known about alcohol consumption in relation to long-term mortality risk after myocardial infarction (MI). We examined alcohol consumption in relation to total, coronary heart disease (CHD) and cardiovascular disease (CVD) mortality in the Alpha Omega Cohort of Dutch post-MI patients. Methods: We included 4,365 patients (60-80y, 79% male) with MI ≤10y before enrolment. Heavy alcohol users (≥6 glasses/d) were excluded from cohort participation. Dietary intake and alcohol consumption were assessed using a 203-item validated food-frequency questionnaire. Patients were classified as non-drinkers (0 g/d, n=956), very light (>0-≤2 g/d, n=385), light (M: >2-≤10, F: >2-≤5 g/d, n=1,125), moderate (M: >10-≤30, F: >5-≤15 g/d, n=1,207) or heavy drinkers (M :>30, F: >15 g/d, n=692). Hazard ratios (HRs) for total, CHD and CVD mortality were obtained, adjusting for age, sex, education, smoking, BMI, physical activity, energy intake and other dietary factors. Results: Alcohol was consumed by 83% of men and 61% of women. During 11.1y follow up, 2,035 deaths occurred of which 575 from CHD and 801 from CVD. Compared to the reference group of very light drinkers, HRs (95%CI) for total mortality were 1.01 (0.85, 1.19) in non-drinkers, and 0.88 (0.74, 1.04), 0.85 (0.72, 1.01) and 0.91 (0.76, 1.10) in light, moderate and heavy drinkers respectively. Adding non-drinkers to the reference group did not affect HRs: 0.87 (0.78, 0.98), 0.85 (0.76, 0.96) and 0.91 (0.79, 1.05) for light, moderate and heavy drinkers. Associations were slightly stronger but non-significant for CVD and CHD mortality. Findings were roughly similar after exclusion of former drinkers (n=385), diabetics (n=883) and patients with poor health (n=1,010). Conclusion: Light to moderate alcohol consumption was weakly inversely associated with total, CVD and CHD mortality risk in post-MI patients. In this observational study, potential bias and confounding cannot be ruled out and findings should be interpreted cautiously in light of the totality of evidence.

scholarly journals Province-specific recalibration of CVD risk models using population-specific routine data for Chinese people is important

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
D Zhang ◽  
L Pennells ◽  
X Liu ◽  
S Kaptoge ◽  
L Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Prediction ◽  
Mortality Risk ◽  
Risk Estimation ◽  
Aggregate Level ◽  
Cvd Risk ◽  
The Future ◽  
Estimation System ◽  
Cvd Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular diseases (CVD) are the leading causes of death in China. Since population CVD incidence and risk factor levels vary considerably across regions in China, geo-specific investment in the prevention of CVD could be advantageous. Risk prediction models are an integral part of CVD prevention guidelines and can be used to help guide intervention. However, there is no CVD model generalizable to the various incidence rates, risk-factor levels and composition of CVD in different regions of China. Purpose To construct a CVD risk estimation system, which is calibrated to CVD risk in different regions in China, and can be regularly updated in the future using routinely available aggregate level CVD incidence and risk factor data, in response to changing trends with time and divergent CVD rates. Methods The risk prediction model used was the WHO CVD score, initially calibrated to predict CVD mortality in the whole of mainland China. Further province-specific recalibration was then completed to give models tailored to the 31 provinces. The recalibration approach used aggregate level province, sex- and age group-specific levels of risk factors and CVD mortality. Risk factor values were estimated using 145 268 participants aged 40-80 years old from the China Chronic Disease and Risk Factors Surveillance, a nationally and provincially representative cross-sectional survey in 2015. Province-specific CVD mortality rates in 2017 were estimated based on published scientific reports, unpublished registry data, and health system administrative data. Results Compared with the province-specific models, the China-specific WHO score overestimated mortality risk in some provinces while underestimating risk in others. For example, while the predicted population risk of 10-year CVD mortality was 3.5% in male in both Shanghai and Hebei using the China-specific score (with province-specific observed risk factor values), the province-specific scores gave predicted population risks of 1.1% for Shanghai and 5.5% for Hebei. Accordingly, using the province-specific scores for an individual with the same combination of risk factors, the 10-year risk of CVD mortality differed substantially across provinces. For example, the estimated 10-year risk for a 60 year old, male smoker without diabetes and systolic blood pressure of 140 mmHg and total cholesterol 5 mmol/L ranged from 2.4% in Shanghai to 13.2% in Tibet. Similarly, the estimated 10-year risk for a female with the same risk factor profile ranged from 1.5% in Shanghai to 11.5% in Tibet. Conclusion We have developed a CVD risk estimation system, which is calibrated to CVD risk in different provinces of China, and can be regularly recalibrated in the future using routinely available information. Application of this approach should help accurately estimate CVD risk in individuals from China, and assist policy makers in making more appropriate decisions about allocation of preventative resources. Abstract Figure. Predicted 10 year CVD mortality risk

scholarly journals Quantifying the contribution of established risk factors to cardiovascular mortality differences between Russia and Norway

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Sergi Trias-Llimós ◽  
Lisa Pennells ◽  
Aage Tverdal ◽  
Alexander V. Kudryavtsev ◽  
Sofia Malyutina ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cvd Risk ◽  
Risk Factor Profile ◽  
Emerging Risk ◽  
The Absolute ◽  
Absolute Age ◽  
Relative Differences ◽  
Mortality Rate Ratio ◽  
Cvd Mortality

AbstractSurprisingly few attempts have been made to quantify the simultaneous contribution of well-established risk factors to CVD mortality differences between countries. We aimed to develop and critically appraise an approach to doing so, applying it to the substantial CVD mortality gap between Russia and Norway using survey data in three cities and mortality risks from the Emerging Risk Factor Collaboration. We estimated the absolute and relative differences in CVD mortality at ages 40–69 years between countries attributable to the risk factors, under the counterfactual that the age- and sex-specific risk factor profile in Russia was as in Norway, and vice-versa. Under the counterfactual that Russia had the Norwegian risk factor profile, the absolute age-standardized CVD mortality gap would decline by 33.3% (95% CI 25.1–40.1) among men and 22.1% (10.4–31.3) among women. In relative terms, the mortality rate ratio (Russia/Norway) would decline from 9–10 to 7–8. Under the counterfactual that Norway had the Russian risk factor profile, the mortality gap reduced less. Well-established CVD risk factors account for a third of the male and around a quarter of the female CVD mortality gap between Russia and Norway. However, these estimates are based on widely held epidemiological assumptions that deserve further scrutiny.

Mortality and associated risk factors in diabetics

1985 ◽  
Vol 110 (4_Suppl) ◽  
pp. S21-S26 ◽  
Author(s):  
R. J. Jarrett ◽  
M. J. Shipley
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Mortality Risk ◽  
Mortality Rates ◽  
Potential Risk Factors ◽  
Diabetic Population ◽  
Associated Risk Factors ◽  
The Relationship

Summary. In 168 male diabetics aged 40-64 years participating in the Whitehall Study, ten-year age adjusted mortality rates were significantly higher than in non-diabetics for all causes, coronary heart disease, all cardiovascular disease and, in addition, causes other than cardiovascular. Mortality rates were not significantly related to known duration of the diabetes. The predictive effects of several major mortality risk factors were similar in diabetics and non-diabetics. Excess mortality rates in the diabetics could not be attributed to differences in levels of blood pressure or any other of the major risk factors measured. Key words: diabetics; mortality rates; risk factors; coronary heart disease. There are many studies documenting higher mortality rates - particularly from cardiovascular disease -in diabetics compared with age and sex matched diabetics from the same population (see Jarrett et al. (1982) for review). However, there is sparse information relating potential risk factors to subsequent mortality within a diabetic population, information which might help to explain the increased mortality risk and also suggest preventive therapeutic approaches. In the Whitehall Study, a number of established diabetics participated in the screening programme and data on mortality rates up to ten years after screening are available. We present here a comparison of diabetics and non-diabetics in terms of relative mortality rates and the influence of conventional risk factors as well as an analysis of the relationship between duration of diabetes and mortality risk.

Abstract P115: How Many Coronary Heart Disease Deaths In Poland In 2020 Might Be Prevented By Further Reductions In Population Risk Factor Levels?

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Piotr Bandosz ◽  
Maria Guzman-Castillo ◽  
Simon Capewell ◽  
Tomasz Zdrojewski ◽  
Julia Critchley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Risk Factor ◽  
Heart Disease ◽  
Smoking Prevalence ◽  
Mortality Rates ◽  
Mortality Reduction ◽  
Scenario Reduction ◽  
Saturated Fats ◽  
Changes In Risk

Background: Poland has experienced one of the most dramatic declines in coronary heart disease (CHD) mortality rates in recent decades. This decline reflects the use of evidence based treatments and, crucially, population wide changes in diet. Our aim is to explore the potential for further gains in Poland by achieving population wide reductions in smoking, dietary salt and saturated fat intake and physical inactivity levels. Methods: A validated and updated policy model was used to forecast potential decreases in CHD deaths by 2020 as consequence of lifestyle and dietary changes in the population. Data from the most recent Polish risk factor survey was used for the baseline (2011). We modeled two different policy scenarios regarding possible future changes in risk factors: A) conservative scenario: reduction of smoking prevalence and physically inactivity rates by 5% between 2011 and 2020, and reduction of dietary consumption of energy from saturated fats by 1% and of salt by 10%. B) ideal scenario: reduction of smoking and physically inactivity prevalence by 15%, and dietary reduction of energy from saturated fats by 3% and of salt by 30%. We also conducted extensive sensitivity analysis using different counterfactual scenarios of future mortality trends. Results: Baseline scenarios. By assuming continuing declines in mortality and no future improvements in risk factors the predicted number of CHD deaths in 2020 would be approximately 13,600 (9,838-18,184) while if mortality rates remain stable, the predicted number of deaths would approximate 22,200 (17,792-26,688). Conservative scenario. Assuming continuing declines in mortality, small changes in risk factors could result in approximately 1,500 (688-2,940) fewer deaths. This corresponds to a 11% mortality reduction. Under the ideal scenario, our model predicted some 4,600 (2,048-8,701) fewer deaths (a 34% mortality reduction). Reduction in smoking prevalence by 5% (conservative scenario) or 15% (ideal scenario) could result in mortality reductions of 4.5% and 13.8% respectively. Decreases in salt intake by 10% or 30% might reduce CHD deaths by 3.0% and 8.6% respectively. Replacing 1% or 3% of dietary saturated fats by poly-unsaturates could reduce CHD deaths by 2.6% or 7.7% Lowering the prevalence of physically inactive people by 5%-15% could decrease CHD deaths by 1.2%-3.7%. Conclusion: Small and eminently feasible population reductions in lifestyle related risk factors could substantially decrease future number of CHD deaths in Poland, thus consolidating the earlier gains.

Abstract P389: Cardiovascular Disease Mortality Risk Prediction in Educational Classes across European Regions, in the MORGAM Project Populations

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Marco M Ferrario ◽  
Giovanni Veronesi ◽  
Lloyd E Chambless ◽  
Hugh Tunstall-Pedoe ◽  
Kari Kuulasmaa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
High Education ◽  
Risk Prediction ◽  
Central Europe ◽  
East Europe ◽  
Hazard Ratios ◽  
Score Risk ◽  
European Populations ◽  
Cvd Mortality

Aims: Although socioeconomic status is a recognized independent risk factor for CVD mortality, the recommended European risk prediction equation for primary prevention does not consider it; an approach criticized by previous results in the UK and US. We aim to assess whether the SCORE project equation adequately estimates the risk in different educational classes, across several European populations. Methods: We considered 47 prospective population-based surveys from Nordic Countries (Finland, Denmark, Sweden), UK (Belfast and Scotland), Central Europe (France, Germany and Italy) and East Europe (Lithuania, Poland) and Russia. Baseline data collection and mortality follow-up (median time 10 years) adhered to standardized MONICA-like procedures. Three educational classes were derived from population-, sex- and birth year-specific tertiles of years of schooling. The individual SCORE risk was computed from age, total cholesterol, systolic blood pressure and smoking; the risk was recalibrated to the average observed risk in each population. We estimated age- and traditional risk factors-adjusted hazard ratios (HR) for 10 year CVD mortality (highest education as the reference), from Cox models. Moreover, the observed number of fatal CVD events by educational class was compared to the expected number, as estimated by the recalibrated SCORE function. Results: The cohorts summed-up 39,215 men and 29,240 women 40 to 64 years old and free from CVD event at baseline. Education was associated with CVD mortality in men (pooled age-adjusted HR for low vs high education: 1.6, 95% CI 1.4–1.9); the hazard ratios ranged from 1.3 (95%CI: 0.9–1.8) in Central Europe to 2.1 (1.6–2.7) in East Europe and Russia. The association attenuated after adjustment for SCORE risk factors and HDL-cholesterol. Among women, the association was significant in Nordic Countries only (age-adjusted HR for low vas high education: 1.7, 95% CI 1.1–2.6), but it was no more significant after adjustment for multiple risk factors. The original SCORE equation overestimated the risk at a population level, both in men and in women, except in East Europe and Russia. After recalibration, the SCORE equation overestimated the risk among the more educated men by 20% to 50% (in Central Europe, East Europe and Russia, respectively), but underestimated it in the less educated men by 7% to 23% (in Central Europe, East Europe and Russia, respectively). Conclusions: Our results, based on a well-harmonized study comprising several European populations, suggest the need to include country-specific socioeconomic status in the risk estimation equations.

Abstract 17: Association of Race and Sex with Cardiovascular Disease and Non-Cardiovascular Disease Mortality: The REasons for Geographic and Racial Differences in Stroke study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Gabriel S Tajeu ◽  
Monika M Safford ◽  
George Howard ◽  
Rikki M Tanner ◽  
Paul Muntner
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Cvd Risk ◽  
Hazard Ratios ◽  
Stroke Study ◽  
Cvd Mortality

Introduction: Black Americans have higher rates of cardiovascular disease (CVD) mortality compared with whites. Differences in sociodemographic, psychosocial, CVD, and other risk factors may explain increased mortality risk. Methods: We analyzed data from 29,015 REasons for Geographic and Racial Differences in Stroke study participants to determine factors that may explain the higher hazard ratio for CVD and non-CVD mortality in blacks compared with whites. Cause of death was adjudicated by trained investigators. Within age-sex sub-groups, we used Cox proportional hazards regression with progressive adjustment to estimate black:white hazard ratios. Results: Overall, 41.0% of participants were black, and 54.9% were women. Over a mean follow-up of 7.1 years (maximum 12.3 years), 5,299 participants died (1,797 CVD and 3,502 non-CVD deaths). Among participants < 65 years of age, the age and region adjusted black:white hazard ratio for CVD mortality was 2.28 (95% CI: 1.68-3.10) and 2.32 (95% CI: 1.80-3.00) for women and men, respectively, and for participants ≥ 65 was 1.54 (95% CI: 1.30-1.82) and 1.35 (95% CI: 1.16-1.57) for women and men, respectively ( Table ). The higher black:white hazard ratios for CVD mortality were no longer statistically significant after multivariable adjustment, with the largest attenuation occurring with sociodemographic and CVD risk factor adjustment. Among participants < 65 years of age, the age and region adjusted black:white hazard ratios for non-CVD mortality were 1.51 (95% CI: 1.24-1.85) and 1.76 (95% CI: 1.46-2.13) for women and men, respectively, and for participants ≥ 65 was 1.12 (95% CI: 1.00-1.26) and 1.34 (95% CI: 1.20-1.49) for women and men, respectively. The higher black:white hazard ratios for non-CVD mortality were attenuated after adjustment for sociodemographics. Conclusions: Black:white differences are larger for CVD than non-CVD causes of death. The increased CVD mortality for blacks compared with whites is primarily explained by sociodemographic and CVD risk factors.

scholarly journals Effects of transport distance and the season of the year on death rates among hens and roosters in transport to poultry processing plants in the Czech Republic in the period from 1997 to 2004

2008 ◽  
Vol 52 (No. 6) ◽  
pp. 262-266 ◽  
Author(s):  
E. Voslarova ◽  
B. Janackova B ◽  
F. Vitula ◽  
A. Kozak ◽  
V. Vecerek
Keyword(s):  
Czech Republic ◽  
Total Mortality ◽  
Mortality Rates ◽  
Death Rates ◽  
The Czech Republic ◽  
Transport Distance ◽  
Processing Plants ◽  
Poultry Processing ◽  
Bird Mortality ◽  
Poor Welfare

Poor welfare is the cause of high mortality among hens and roosters transported to poultry processing plants. In the Czech Republic, death rates among hens and roosters in transport to poultry slaughter plants were monitored between 1997 and 2004, and their total mortality rate was in the 0.925% &plusmn; 0.479% range. Death rates among hens and roosters were influenced by the transport distance to poultry processing plants. The percentage of dead birds increased from 0.592% &plusmn; 0.575% at transport distances up to 50 km to 1.638% &plusmn; 0.952% at transport distances up to 300 km. The bird mortality was also influenced by the season of the year. Higher mortality rates were ascertained during the cold months of the year, specifically in October through to April.

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