Study: Black Patients Have Greater Risk of All-Cause Mortality From Diabetes, Stroke

In the United States, Black adults have greater rates of all-cause mortality because of diabetes, coronary heart disease (CHD), and stroke, according to a study published in JAMA Network Open.

At 15 years of follow-up, investigators found that 18% of participants had diabetes compared with 4% having CHD and 2% with history of stroke. As a standalone cardiometabolic morbidity, diabetes was the least likely of the 3 comorbidities to cause crude all-cause mortality.

Risk for mortality increased if a patient had diabetes and stroke, but “the combination of diabetes, stroke, and CHD was associated with the highest all-cause mortality,” the study authors wrote. “The unadjusted risk of all-cause mortality was increased approximately 10-fold and risk of CHD mortality was increased approximately 43-fold.”

In the Jackson Heart Study (JHS), a prospective secondary analysis, researchers enrolled 5064 Black adults to examine risk and events of all-cause mortality and CHD mortality from diabetes, CHD, and stroke, in Jackson, Missouri.

Among participants with a single cardiometabolic morbidity, stroke carried the greatest risk of all-cause mortality. But among adults with all 3 conditions, the crude mortality rate per 1000 person-years was higher among Black adults. There were 84.1 deaths per 1000 person-years in JHD participants, compared to 60 deaths per 1000 person-years among white adults in the Emerging Risk Factors Collaboration (ERFC).

Additionally, Black individuals with all 3 morbidities were more likely to be men who were older and less educated. This same group of individuals were more at risk for all-cause mortality or CHD mortality as well.

Study limitations includes participants originating from 1 geographical area. The cardiometabolic morbidities were not adjusted over the course of the study either, and potential residual confounding may have occurred. Finally, socioeconomic status and lifestyle behaviors were accounted for, but may not have been evaluated as confounders.

Any individual with diabetes has an increased risk of cardiovascular disease, cardiovascular mortality, and all-cause mortality; however, Black populations in the United States have higher rates of diagnosed and undiagnosed diabetes. This population is also 2-times more likely to face all-cause mortality compared to White populations.

CVD affects more younger Black populations and CHD is also more deadly, according to the study. Further, risk of mortality from stroke can be 5-times greater in Black populations.

Preventative interventions can include addressing social determinants of health and performing upstream intervention of sociopolitical and economic factors—such as structural racism and access to quality education—and impacting psychological, environmental, and biological stressors.

“Given the increasing prevalence of obesity and type 2 diabetes in the US, along with recent increases in cardiovascular mortality, it is imperative to accelerate the development and implementation of preventive interventions to decrease cardiometabolic disease and advance treatment and care among those with cardiometabolic conditions,” the study authors wrote.

Reference

Joseph, Joshua, Rajwani, Aaskash, Roper, Daniel, et al. Associations of Cardiometabolic Multimorbidity With All-Cause and Coronary Heart Disease Mortality Among Black Adults in the Jackson Heart Study. JAMA Netw Open. 2022;5(10):e2238361. doi:10.1001/jamanetworkopen.2022.38361