Sudden cardiac death: low income largely explains race-based disparities

  • Zhao D & al.
  • Circulation
  • 4 Feb 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Black people in the United States, especially black women, suffer sudden cardiac death (SCD) at higher rates than do white people.
  • Powerful predictive factors include income and education.
  • Preventive efforts are needed.

Why this matters

  • Black people suffer higher out-of-hospital SCD compared with whites.
  • Reasons for disparity have not previously been sought among large community cohorts. 

Key results

  • Over median 27.4-year follow-up, 547 participants experienced SCD.
  • SCD cumulative incidence at age 85 years (95% CIs):
    • Black men: 9.6% (7.7%-11.5%);
    • Black women: 6.6% (5.3%-7.9%);
    • White men: 6.5% (5.6%-7.4%); and
    • White women: 2.3% (1.8%-2.9%).
  • Blacks vs whites, SCD HRs (95% CIs):
    • Sex-adjusted: 2.12 (1.79-2.51).
    • Adjusted for socioeconomic, cardiovascular, and electrocardiographic risk factors: 1.38 (1.11-1.71).
  • Blacks vs whites, excess risks:
    • Socioeconomic factors, cardiovascular risk factors, and electrocardiographic variables explained 65.3% (95% CI, 37.9%-92.8%) of the difference.
    • Income explained 50.5% of the difference, dwarfing education (19.1%), hypertension (22.1%), and diabetes (19.6%). 

Study design

  • Analysis of multicenter prospective cohort Atherosclerosis Risk in Communities Study (ARIC; 3832 blacks and 11,237 whites).
  • Outcome: Cumulative adjudicated SCD incidence; predictive factors.
  • Funding: NIH.

Limitations

  • No information on SCD etiologies, access to care, resuscitation.

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