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Heart Disease - Epidemiology Since the late 1960s, CHD mortality for all four major genderracial groups has declined; however, since 1980, CHD rates have declined faster in whites than in blacks, particularly for men. Attempts to explain the disparities between blacks and whites in CHD morbidity and mortality, as well as differences in the use of clinical, diagnostic, and therapeutic resources, have been limited by the scarcity of comprehensive data on CHD in blacks.Relationships between risk factors and CHD have been clarified in recent years and appear to be universally applicable, although data from specific ethnic subpopulations have not been consistent with findings in whites. Prospective epidemiological studies indicate that CHD rates are similar in black men and white men, but higher in black women than in white women. Local and regional data suggest that blacks have higher outofhospital deaths, fewer hospitalizations for acute myocardial infarction (MI), higher death rates from cardiovascular disease, and utilize cardiac diagnostic procedures and revascularization procedures less than whites. National surveys and clinical trial data provide valuable information, but have not been thoroughly analyzed for clinical comparisons of subpopulations. Racial and ethnic identifiers are often variable or absent in existing large data sets. Ongoing observational studies may be informative in the future. Data from many of these studies could be collected and analyzed to provide a more comprehensive overview of CHD in blacks. Other than Medicare data, which are confined to the population over 65 years old, there is no national data base that contains comprehensive clinical information on blacks. National data on clinical characteristics, risk factor profiles, therapies received, health care providers, patient preferences, and longterm health outcomes are not available in blacks. An additional important issue in data analysis relates to the interpretation of exposure (i.e., outcome relationships in blacks compared with whites). In the complex, causal pathway linking risk factors to disease outcomes, available analysis procedures may not be adequate to define differences between blacks and whites. Epidemiology (Data Collection and Analysis) The fundamental obstacle in studying CHD in blacks is the absence of sufficient data for resolving many of the questions related to racial comparisons. Because information is limited for specific racial and ethnic groups, determining whether differences and inconsistencies are due to chance findings, artifacts in reporting, or important genetic and biological factors is a difficult, but not insurmountable, problem. Data collected previously from large clinical trials, national surveys, and vital statistics sources have not been analyzed collectively. When integrated, they may contain valuable information on CHD in blacks. By merging national and regional data on CHD in blacks, it will be possible to obtain a more complete picture of the effectiveness of therapeutic interventions, determinants in the utilization of cardiological care and resources, medical practice patterns, and outcomes of hospital and ambulatory services. Based on these data, research needs and information gaps can be further clarified, and plans for future analyses of prospectively collected data can be formulated. In conducting research on CHD in blacks, it is important to distinguish healthrelated consequences of social and economic factors from biological or genetic processes that may be active in the pathogenesis, clinical expression, and outcomes of CHD in blacks. The appropriate use of racial categories in biomedical research should be defined and the limitations of these categories well understood. Studies of the magnitude of betweengroup genetic differences, and withingroup heterogeneity, should be given high priority. Caution must be exercised in interpreting differences between population subgroups so that the contribution of genetic factors, such as race, is not overemphasized. The distinctive roles of environmental forces, such as socioeconomic status and stress related to minority status, and the genetics and biological aspects of race should be clarified. |
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