Association of race with mortality and cardiovascular events in a large cohort of US veterans

Csaba Kovesdy, Keith C. Norris, L. Ebony Boulware, Jun L. Lu, Jennie Z. Ma, Elani Streja, Miklos Z. Molnar, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

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Abstract

Background - In the general population, blacks experience higher mortality than their white peers, attributed in part to their lower socioeconomic status, reduced access to care, and possibly intrinsic biological factors. Patients with kidney disease are a notable exception, among whom blacks experience lower mortality. It is unclear if similar differences affecting outcomes exist in patients with no kidney disease but with equal or similar access to health care. Methods and Results - We compared all-cause mortality, incident coronary heart disease, and incident ischemic stroke using multivariable-adjusted Cox models in a nationwide cohort of 547 441 black and 2 525 525 white patients with baseline estimated glomerular filtration rate ≥60 mL·min-1·1.73 m-2 receiving care from the US Veterans Health Administration. In parallel analyses, we compared outcomes in black versus white individuals in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. After multivariable adjustments in veterans, black race was associated with 24% lower all-cause mortality (adjusted hazard ratio, 0.76; 95% confidence interval, 0.75-0.77; P<0.001) and 37% lower incidence of coronary heart disease (adjusted hazard ratio, 0.63; 95% confidence interval, 0.62-0.65; P<0.001) but a similar incidence of ischemic stroke (adjusted hazard ratio, 0.99; 95% confidence interval, 0.97-1.01; P=0.3). Black race was associated with a 42% higher adjusted mortality among individuals with estimated glomerular filtration rate ≥60 mL·min-1·1.73 m-2 in NHANES (adjusted hazard ratio, 1.42; 95% confidence interval, 1.09-1.87). Conclusions - Black veterans with normal estimated glomerular filtration rate and equal access to healthcare have lower all-cause mortality and incidence of coronary heart disease and a similar incidence of ischemic stroke. These associations are in contrast to the higher mortality experienced by black individuals in the general US population.

Original languageEnglish (US)
Pages (from-to)1538-1548
Number of pages11
JournalCirculation
Volume132
Issue number16
DOIs
StatePublished - Oct 20 2015

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Veterans
Mortality
Glomerular Filtration Rate
Confidence Intervals
Coronary Disease
Nutrition Surveys
Stroke
Incidence
Kidney Diseases
Veterans Health
United States Department of Veterans Affairs
Intrinsic Factor
Health Services Accessibility
Biological Factors
Proportional Hazards Models
Social Class
Population
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Kovesdy, C., Norris, K. C., Boulware, L. E., Lu, J. L., Ma, J. Z., Streja, E., ... Kalantar-Zadeh, K. (2015). Association of race with mortality and cardiovascular events in a large cohort of US veterans. Circulation, 132(16), 1538-1548. https://doi.org/10.1161/CIRCULATIONAHA.114.015124

Association of race with mortality and cardiovascular events in a large cohort of US veterans. / Kovesdy, Csaba; Norris, Keith C.; Boulware, L. Ebony; Lu, Jun L.; Ma, Jennie Z.; Streja, Elani; Molnar, Miklos Z.; Kalantar-Zadeh, Kamyar.

In: Circulation, Vol. 132, No. 16, 20.10.2015, p. 1538-1548.

Research output: Contribution to journalArticle

Kovesdy, C, Norris, KC, Boulware, LE, Lu, JL, Ma, JZ, Streja, E, Molnar, MZ & Kalantar-Zadeh, K 2015, 'Association of race with mortality and cardiovascular events in a large cohort of US veterans', Circulation, vol. 132, no. 16, pp. 1538-1548. https://doi.org/10.1161/CIRCULATIONAHA.114.015124
Kovesdy, Csaba ; Norris, Keith C. ; Boulware, L. Ebony ; Lu, Jun L. ; Ma, Jennie Z. ; Streja, Elani ; Molnar, Miklos Z. ; Kalantar-Zadeh, Kamyar. / Association of race with mortality and cardiovascular events in a large cohort of US veterans. In: Circulation. 2015 ; Vol. 132, No. 16. pp. 1538-1548.
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abstract = "Background - In the general population, blacks experience higher mortality than their white peers, attributed in part to their lower socioeconomic status, reduced access to care, and possibly intrinsic biological factors. Patients with kidney disease are a notable exception, among whom blacks experience lower mortality. It is unclear if similar differences affecting outcomes exist in patients with no kidney disease but with equal or similar access to health care. Methods and Results - We compared all-cause mortality, incident coronary heart disease, and incident ischemic stroke using multivariable-adjusted Cox models in a nationwide cohort of 547 441 black and 2 525 525 white patients with baseline estimated glomerular filtration rate ≥60 mL·min-1·1.73 m-2 receiving care from the US Veterans Health Administration. In parallel analyses, we compared outcomes in black versus white individuals in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. After multivariable adjustments in veterans, black race was associated with 24{\%} lower all-cause mortality (adjusted hazard ratio, 0.76; 95{\%} confidence interval, 0.75-0.77; P<0.001) and 37{\%} lower incidence of coronary heart disease (adjusted hazard ratio, 0.63; 95{\%} confidence interval, 0.62-0.65; P<0.001) but a similar incidence of ischemic stroke (adjusted hazard ratio, 0.99; 95{\%} confidence interval, 0.97-1.01; P=0.3). Black race was associated with a 42{\%} higher adjusted mortality among individuals with estimated glomerular filtration rate ≥60 mL·min-1·1.73 m-2 in NHANES (adjusted hazard ratio, 1.42; 95{\%} confidence interval, 1.09-1.87). Conclusions - Black veterans with normal estimated glomerular filtration rate and equal access to healthcare have lower all-cause mortality and incidence of coronary heart disease and a similar incidence of ischemic stroke. These associations are in contrast to the higher mortality experienced by black individuals in the general US population.",
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AU - Norris, Keith C.

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AU - Ma, Jennie Z.

AU - Streja, Elani

AU - Molnar, Miklos Z.

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