Diabetes, stroke, and coronary heart disease associated with increased mortality among Black adults: Jackson Heart Study

1. The Jackson Heart Study evaluating the association of cardiometabolic conditions with mortality in Black patients demonstrated that diabetes, stroke, and coronary heart disease (CHD) independently were associated with increased risk of all-cause mortality.

2. The risks of all-cause mortality and CHD mortality were increased among patients with all three cardiometabolic conditions compared to any alone.

Evidence Rating Level: 2 (Good)

Study Rundown: Life expectancy differs among Black and White populations, with diabetes, stroke, and coronary heart disease (CHD) shown to be major contributors. The association of these three conditions, independently and collectively, with mortality, has been studied extensively in White populations. However, despite the greater prevalence of these comorbidities in Black populations, there is a lack of data that has explored and quantified the risk in this cohort. Therefore, the prospective cohort Jackson Heart Study (JHS) assessed independent and multiplicative associations of diabetes, stroke, and CHD with all-cause and CHD mortality among Black adults. Patients were included in the study between 2000 and 2004 with follow-up for a median of 15 years through May 31, 2018. In the adjusted model, all-cause mortality was significantly increased in patients with diabetes (HR: 1.50 [95% CI: 1.22-1.85]), stroke (HR: 1.74 [95% CI: 1.24-2.42]), and CHD (HR: 1.59 [95% CI: 1.22-2.08]); the risk was greatest among those with all three conditions (HR: 3.68 [95% CI: 1.96-6.93]). Diabetes (HR: 1.95 [95% CI: 0.96-3.97]) or stroke (HR: 1.31 [95% CI: 0.31-5.59]) alone were not associated with an increased risk of CHD mortality. However, CHD alone (HR: 3.51 [95% CI: 1.56-7.90]) was associated with a significantly increased risk of CHD mortality. Additionally, the association of all three cardiometabolic multi-morbidities had the highest risk of CHD mortality (HR: 13.52 [95% CI: 3.38-54.12]). Overall, the JHS study demonstrated that Black patients with cardiometabolic conditions have a significantly increased risk of mortality, with the greatest risk among those with all three risk factors. This study was strengthened by its large Black cohort with greater than 15 years of follow-up. However, one limitation of this study is that it was confined to one geographic area and may not be generalizable to all Black adults in the United States.

Click to read the study in JAMA

Relevant Reading: Association of cardiometabolic multimorbidity with mortality

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