Presentation Abstract

Session: 11-Health Disparities
Friday, Mar 25, 2011, 1:30 PM - 3:00 PM
Presentation: 050 - Urban-Rural Disparities in Coronary Heart Disease Mortality Remain High among Blacks
Location: Atrium Ballroom A
Pres. Time: Friday, Mar 25, 2011, 2:10 PM - 2:25 PM
Category: +EPI - Ethnic Disparities
Keywords: Coronary artery disease; Country level epidemiologic data; Racial/ethnic disparities
Author(s): Ambar Kulshreshtha, Emir Veledar, Kaustubh C Dabhadkar, Viola Vaccarino, Emory Univ, Atlanta, GA
Abstract: Background: Urban-rural differentials exist in the United States for both socio-economical and cultural reasons. Although coronary heart disease (CHD) mortality has declined in the past few decades, it is unclear whether reduction in CHD deaths has been similar across urbanization levels in specific racial groups. We sought to describe the pattern and magnitude of these urban-rural variations in CHD mortality in US.
Methods: We used data from the National Center for Health Statistics to examine trends in CHD death rates (ICD-10 codes I20-I25 and I00-I99) between 1999 and 2006 among persons 35- 84 years of age by urbanization, race and geographical area. Crude and adjusted changes in CHD mortality rates were calculated in the overall population and in specific racial and urbanization groups: blacks and whites in large metro areas (urban), medium and small metros, and non-metros (rural). We further examined these differences for each region (South, Mid-West, North-East and West). Poisson regression was used to model data.
Results: Race and urbanization were independent predictors of CHD mortality. From 1999 to 2006, there was an overall 30% decline in CHD mortality. However, the decline was less in rural areas (26%) compared to urban areas (31%). Age-adjusted CHD mortality rate was 8% higher in rural vs. urban areas. The Figure presents trends in CHD deaths for specific racial and urbanization subgroups from 1999 to 2006. CHD death rates declined slightly more for whites (28%) than in blacks (23%) and the decline was most pronounced for whites living in urban areas (33%) and least pronounced for blacks in rural areas (24%). Comparing regions, blacks in rural areas in the South had 20% higher mortality than blacks in urban areas. Paradoxically, blacks in other regions have lower mortality in rural than urban areas.
Conclusion: CHD mortality has declined across all racial-urbanization groups in the last decade. However, favorable national level trends may mask less favorable trends in certain regions (e.g. blacks living in rural South).
Disclosures:  A. Kulshreshtha: None. E. Veledar: None. K.C. Dabhadkar: None. V. Vaccarino: None.