Jan 1, 2008 - diovascular disease, and stroke have left Black patients with a particularly .... American Journal of Public Health | January 2008, Vol 98, No. 1.
RESEARCH AND PRACTICE
Differences in Cardiovascular Disease Mortality Associated With Body Mass Between Black and White Persons | Jill E. Abell, PhD, MPH, Brent M. Egan, MD, Peter W. F. Wilson, MD, Stuart Lipsitz, ScD, Robert F. Woolson, PhD, and Daniel T. Lackland, DrPH
We analyzed cardiovascular disease mortality risks associated with obesity using participant-level metaanalysis of data from the Black Pooling Project for Black and White individuals. The adjusted relative risks (ARRs) were stronger among White participants than among Black participants for coronary heart disease AAR=1.21 (95% confidence interval [CI] = 1.07, 1.36) versus 0.87 (95% CI=0.69, 1.09), respectively, and cardiovascular disease ARR=1.18 (95% CI = 1.07, 1.29) versus 0.91 (95% CI=0.77, 1.05), repectively. The results suggest that obesity is an independent risk factor in White people, and additional study of body size and disease progression is necessary in the assessment of racial disparities. (Am J Public Health. 2008;98:63–66. doi:10. 2105/AJPH.2006.093781)
Increased body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) has been associated with increased risks for cardiovascular disease.1–4 Likewise, the racial disparities in obesity, cardiovascular disease, and stroke have left Black patients with a particularly heavy disease burden.5–7 However, the disease risks attributed to obesity are inconsistent and less clear for Black individuals than for White individuals.1,3,4,8–22 The association between obesity and cardiovascular disease is limited because of the relative paucity of long-term follow-up outcomes for Black men and women. We examined the association between BMI and
450 000 person-years (82 893 Black and 368 069 White).
coronary heart disease (CHD), stroke, and cardiovascular disease mortality by reviewing data from the Black Pooling Project, which includes more than 450 000 person-years of follow-up.
Analysis We used 3 Cox proportional hazards regression models to calculate the relative risk of CHD, stroke, and cardiovascular disease mortality associated with obesity (BMI ≥ 30 kg/m2), with normal weight (BMI = 18.5–24.9 kg/m2) as the referent group. The covariates in each of these models were chosen a priori. Model 1 was adjusted for age; model 2 for age and smoking status; and model 3 for age, smoking status, hypertension, cholesterol, and diabetes. We ran these models for each race group (Black and White) and each gender in both race groups (Black and White men and women) separately in each of the 4 cohorts and then pooled
METHODS Data Source The Black Pooling Project includes participantlevel data on 27 691 persons (4853 Black and 22 838 White) from 4 studies: Evans County Heart Study, Charleston Heart Study, and National Health and Nutrition Examination Survey I and II (NHANES I and II). Baseline values, collected between 1960 and 1980, included height, weight, blood pressure, cholesterol, diabetes status, and smoking status.23–27 Mortality follow-up ranged from 15 to 30 years and included more than
TABLE 1—Sample Characteristics for Black and White Women and Men: Black Pooling Project Black Total Total sample, No. Deaths, No. (%) Cardiovascular disease deaths Coronary heart disease deaths Stroke deaths Person-years Age, y, mean (SD) Blood pressure, mm Hg, mean (SD) Systolic blood pressure Diastolic blood pressure Cholesterol, mg/dL, mean (SD) BMI,a % Underweight Normal weight Overweight Obese Morbidly obese Diabetes, % Smoking status, % Nonsmoker Former smoker Current smoker
Women
White Men
Total
Women
Men
4853
2843
2010
22 838
12 739
10 099
1165 (24) 569 (12) 302 (6) 82 893 51.1 (14)
636 (22) 297 (10) 174 (6) 50 881 50.1 (14)
529 (26) 272 (14) 128 (6) 32 012 52.7 (14)
3738 (16) 2388 (10) 631 (3) 368 069 51.3 (14)
1654 (13) 980 (8) 343 (3) 215 400 50.4 (15)
2084 (21) 1408 (14) 288 (3) 152 669 52.4 (14)
148 (32) 91 (16) 220 (48)
149 (34) 90 (16) 223 (49)
147 (29) 92 (16) 216 (46)
134 (23) 83 (12) 224 (48)
133 (25) 82 (12) 227 (51)
136 (21) 85 (12) 221 (45)
4 38 32 17 9 6
5 31 31 21 13 7
4 48 34 11 3 5
4 47 34 11 4 4
4 51 27 12 6 4
3 42 43 11 2 4
54 9
66 6
36 13
46 21
59 13
29 31
37
28
51
33
28
40
a
BMI = body mass index; weight in kilograms divided by height in meters squared, Underweight was defined as
