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Between 2000 and 2022, Black Americans experienced nearly 800 000 excess age-adjusted deaths and 24 million excess years of potential life lost (YPLL) due to cardiovascular disease (CVD) compared to White individuals, according to a new “report card” published in the Journal of the American College of Cardiology (JACC).¹

Ischemic heart disease, hypertension (HTN), cerebrovascular disease, and heart failure (HF) were identified as leading components contributing to excess mortality and YPLL among Black Americans, researchers reported.¹

“This staggering figure highlights the critical need for systemic changes in addressing cardiovascular inequities,” senior author Harlan M. Krumholz, MD, the Harold H. Hines, Jr. Professor of Medicine at Yale School of Medicine and incoming editor-in-chief of JACC, said in an American College of Cardiology (ACC) press release.²

Krumholz and colleagues conducted the study to assess the extent of racial disparities in CVD outcomes between Black and White individuals in the US. “Understanding the extent of these disparities and how they change over time is crucial for accountability and motivates national reporting that can highlight societal progress in health equity,” they wrote.¹

Investigators examined national death certificate data from the US Centers for Disease Control and Prevention’s Wide-ranging ONline Data for Epidemiologic Research (WONDER) database between 2000 and 2022. They stratified individuals according to 5-year age groups as well as by non-Hispanic Black and non-Hispanic White populations. The causes of death defined as CVD were ischemic heart disease, HTN, cerebrovascular disease, and HF. They then calculated age-adjusted mortality rates (AAMR) for each of the 4 diseases by weighting the crude death rate by the fraction of individuals in that age group according to the 2000 population distribution.¹

Krumholz and colleagues computed excess AAMR by subtracting the estimated AAMR of White Americans from the AAMR of Black Americans. YPLL—defined as the number of years a person would have lived had they not died when they did—was estimated by multiplying the 5-year age group crude mortality rate by the life expectancy of White individuals for that age group, gender, and year. The excess YPLL was computed by subtracting the estimated YPLL of White Americans from the estimated YPLL of Black Americans.¹

Findings¹

Total excess AAMR for overall CVD in women decreased from 164.8 per 100 000 in 2000 to 95.1 in 2012. These rates plateaued, then increased to 113.1 in 2020 before returning to pre-pandemic levels by 2022. Similarly, for men, this measure decreased from 195 per 100 000 in 2000 to 142 until it hit a plateau in 2011, then increased to 186.7 in 2020 before returning to pre-pandemic levels by 2022.

Researchers observed that between 2000 and 2022, there were an estimated 779 387 excess deaths and 23.7 million excess YPLL due to CVD among Black Americans compared to White Americans. Black women and men had an extra 362 887 and 416 500 excess deaths as well as 11.2 and 12.5 million excess YPLL, respectively, compared with their White counterparts, according to the results.

These findings were maintained when the causes of death were broken into subcategories:

• Ischemic heart disease: Approximately 257 327 excess deaths and 7.9 million excess YPLL among Black individuals compared to White individuals.
• HTN: Approximately 191 097 excess deaths and 5.8 million excess YPLL due to HTN among Black persons compared to White persons.
• Cerebrovascular disease: Approximately 154 541 excess deaths and 4.7 million excess YPLL among Black individuals compared to White individuals.
• HF: Approximately 46 578 excess deaths and 1.3 million excess YPLL among Black Americans compared to White Americans.

“Despite the triumphant reduction in cardiovascular morbidity and mortality over the last 50 years, those declines evolved at racially disproportionate rates resulting in not just health inequities, but life inequities,” Krumholz and colleagues wrote. “The disparities are evident across different subcategories, including ischemic heart disease, hypertension, cerebrovascular disease and heart failure. Moreover, the sharp increases during the pandemic indicate the specific vulnerability of this group during a public health crisis and the need to mitigate this risk in future pandemics.”

Study provides “a stark reminder.”³In an accompany editorial, Jennifer H. Mieres, MD, of Northwell Health and chair of the ACC’s Diversity and Inclusion Committee, and colleagues stated that the study “provides a stark reminder that despite the significant advancements in the treatment of CVD persistent disparities in care and outcomes disproportionally affect Black Americans.”

Mieres and coauthors posit that social determinants of health and structural racism may be drivers of much of the excess cardiovascular mortality observed in Black individuals and call for a refocusing of efforts. “Advancing equity in CV health and health care is possible, actionable and should be a top priority of the entire CV community, including health care systems and CV teams,” they wrote.

References:

1. Krumholz HM, Arun AS, Sawano M, et al. Excess cardiovascular mortality among black Americans 2000-2022: A JACC report card. JACC. Published online June 18, 2024. doi:10.1016/j.jacc.2024.06.004
2. JACC report card highlights inequities in CV care, death rates. JACC. News item. June 18, 2024. Accessed June 19, 2024. https://www.acc.org/About-ACC/Press-Releases/2024/06/18/13/44/JACC-Report-Card-Highlights-Inequities-in-CV-Care-Death-Rates
3. Mieres JH, Kuvin JT, Roswell RO. Cardiovascular health, Juneteenth 2024: Are we thriving together or not? JACC. Published online June 18, 2024. doi:10.1016/j.jacc.2024.06.005