Skip to main content
Open Access Publications from the University of California

Association of Race with Mortality and Cardiovascular Events in a Large Cohort of US Veterans

  • Author(s): Kovesdy, CP
  • Norris, KC
  • Ebony Boulware, L
  • Lu, JL
  • Ma, JZ
  • Streja, E
  • Molnar, MZ
  • Kalantar-Zadeh, K
  • et al.

© 2015 by the American College of Cardiology Foundation and the American Heart Association, Inc. BACKGROUND—: In the general population African-Americans experience higher mortality than their white peers, attributed, in part, to their lower socio-economic status, reduced access to care and possibly intrinsic biologic factors. A notable exception are patients with kidney disease, among whom African-Americans experience lower mortality. It is unclear if similar differences affecting outcomes exist in patients with no kidney disease but with similar access to health care. METHODS AND RESULTS—: We compared all-cause mortality, incident coronary heart disease (CHD) and incident ischemic stroke using multivariable adjusted Cox models in a nationwide cohort of 547,441 African-American and 2,525,525 white patients with baseline estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73m receiving care from the US Veterans Health Administration. In parallel analyses we compared outcomes in African-American vs. white individuals in the National Health and Nutrition Examination Survey 1999-2004 (NHANES). After multivariable adjustments in veterans, African-American race was associated with 24% lower all-cause mortality (adjusted hazard ratio (aHR), 95% confidence interval (CI): 0.76, 0.75-0.77, p<0.001) and 37% lower incidence of CHD (aHR, 95%CI: 0.63, 0.62-0.65, p<0.001), but similar incidence of ischemic stroke (aHR, 95%CI: 0.99, 0.97-1.01, p=0.3). African-American race was associated with a 42% higher adjusted mortality among individuals with eGFR≥60 ml/min/1.73m in NHANES (aHR, 95%CI: 1.42 (1.09-1.87)). CONCLUSIONS—: African-American veterans with normal eGFR have lower all-cause mortality and incidence of CHD, and similar incidence of ischemic stroke. These associations are in contrast with the higher mortality experienced by African-American individuals in the general US population.

Many UC-authored scholarly publications are freely available on this site because of the UC Academic Senate's Open Access Policy. Let us know how this access is important for you.

Main Content
Current View