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Mortality differences between black and white men in the USA: contribution of income and other risk factors among men screened for the MRFIT. MRFIT Research Group. Multiple Risk Factor Intervention Trial.
Lancet 1998; 351(9107):934-9Lct

Abstract

BACKGROUND

Studies of underlying differences in adult mortality between black and white individuals in the USA have been constrained by limitations of data or small study size. We investigated the extent to which differences in socioeconomic position between black and white men contribute to differences in all-cause and cause-specific mortality.

METHODS

361,662 men were screened for the Multiple Risk Factor Intervention Trial between 1973 and 1975, in 22 sites. Median family income of households by zipcode (postal) area of residence was available for 20,224 black and 300,685 white men as well as data on age, cigarette smoking, blood pressure, serum cholesterol, previous heart attack, and treatment for diabetes. We classified deaths during 16 years of follow-up into specific causes and compared differences in death rates between black men and white men, before and after adjustment for differences in income and other risk factors.

FINDINGS

Age-adjusted relative risk of death (black vs white) was 1.47 (95% CI 1.42-1.53). Adjustment for diastolic blood pressure, serum cholesterol, cigarette smoking, medication for diabetes, and previous admission to hospital for heart attack decreased the relative risk to 1.40 (1.35-1.46). Adjustment for income but not the other risk factors decreased the risk to 1.19 (1.14-1.24) and adjustment for other risk factors did not alter this estimate. For cardiovascular death, relative risk on adjustment for income was decreased from 1.36 to 1.09; for cancer from 1.47 to 1.25; and for non-cardiovascular and non-cancer deaths from 1.71 to 1.26. For some specific causes of death, including prostate cancer, myeloma, and hypertensive heart disease, the higher death rates among black men did not seem to reflect differences in income. Rates of death for suicide and melanoma were lower among black than white men, as were those for coronary heart disease after adjustment for income.

INTERPRETATION

Socioeconomic position is the major contributor to differences in death rates between black and white men. Differentials in mortality from some specific causes do not simply reflect differences in income, however, and more detailed investigations are needed of how differences are influenced by environmental exposures, lifetime socioeconomic conditions, lifestyle, racism, and other sociocultural and biological factors.

Authors+Show Affiliations

Department of Social Medicine, University of Bristol, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

9734939

Citation

Davey Smith, G, et al. "Mortality Differences Between Black and White Men in the USA: Contribution of Income and Other Risk Factors Among Men Screened for the MRFIT. MRFIT Research Group. Multiple Risk Factor Intervention Trial." Lancet (London, England), vol. 351, no. 9107, 1998, pp. 934-9.
Davey Smith G, Neaton JD, Wentworth D, et al. Mortality differences between black and white men in the USA: contribution of income and other risk factors among men screened for the MRFIT. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Lancet. 1998;351(9107):934-9.
Davey Smith, G., Neaton, J. D., Wentworth, D., Stamler, R., & Stamler, J. (1998). Mortality differences between black and white men in the USA: contribution of income and other risk factors among men screened for the MRFIT. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Lancet (London, England), 351(9107), pp. 934-9.
Davey Smith G, et al. Mortality Differences Between Black and White Men in the USA: Contribution of Income and Other Risk Factors Among Men Screened for the MRFIT. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Lancet. 1998 Mar 28;351(9107):934-9. PubMed PMID: 9734939.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality differences between black and white men in the USA: contribution of income and other risk factors among men screened for the MRFIT. MRFIT Research Group. Multiple Risk Factor Intervention Trial. AU - Davey Smith,G, AU - Neaton,J D, AU - Wentworth,D, AU - Stamler,R, AU - Stamler,J, PY - 1998/9/12/pubmed PY - 1998/9/12/medline PY - 1998/9/12/entrez SP - 934 EP - 9 JF - Lancet (London, England) JO - Lancet VL - 351 IS - 9107 N2 - BACKGROUND: Studies of underlying differences in adult mortality between black and white individuals in the USA have been constrained by limitations of data or small study size. We investigated the extent to which differences in socioeconomic position between black and white men contribute to differences in all-cause and cause-specific mortality. METHODS: 361,662 men were screened for the Multiple Risk Factor Intervention Trial between 1973 and 1975, in 22 sites. Median family income of households by zipcode (postal) area of residence was available for 20,224 black and 300,685 white men as well as data on age, cigarette smoking, blood pressure, serum cholesterol, previous heart attack, and treatment for diabetes. We classified deaths during 16 years of follow-up into specific causes and compared differences in death rates between black men and white men, before and after adjustment for differences in income and other risk factors. FINDINGS: Age-adjusted relative risk of death (black vs white) was 1.47 (95% CI 1.42-1.53). Adjustment for diastolic blood pressure, serum cholesterol, cigarette smoking, medication for diabetes, and previous admission to hospital for heart attack decreased the relative risk to 1.40 (1.35-1.46). Adjustment for income but not the other risk factors decreased the risk to 1.19 (1.14-1.24) and adjustment for other risk factors did not alter this estimate. For cardiovascular death, relative risk on adjustment for income was decreased from 1.36 to 1.09; for cancer from 1.47 to 1.25; and for non-cardiovascular and non-cancer deaths from 1.71 to 1.26. For some specific causes of death, including prostate cancer, myeloma, and hypertensive heart disease, the higher death rates among black men did not seem to reflect differences in income. Rates of death for suicide and melanoma were lower among black than white men, as were those for coronary heart disease after adjustment for income. INTERPRETATION: Socioeconomic position is the major contributor to differences in death rates between black and white men. Differentials in mortality from some specific causes do not simply reflect differences in income, however, and more detailed investigations are needed of how differences are influenced by environmental exposures, lifetime socioeconomic conditions, lifestyle, racism, and other sociocultural and biological factors. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/9734939/Mortality_differences_between_black_and_white_men_in_the_USA:_contribution_of_income_and_other_risk_factors_among_men_screened_for_the_MRFIT__MRFIT_Research_Group__Multiple_Risk_Factor_Intervention_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140673600800100 DB - PRIME DP - Unbound Medicine ER -