{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T07:03:56Z","timestamp":1793948636339,"version":"4.8.0"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2022,7,19]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite improvements in population health, marked racial and ethnic disparities in longevity and cardiovascular disease (CVD) mortality persist. This study aimed to describe risks for all-cause and CVD mortality by race and ethnicity, before and after accounting for socioeconomic status (SES) and other factors, in the MESA study (Multi-Ethnic Study of Atherosclerosis).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>MESA recruited 6814 US adults, 45 to 84 years of age, free of clinical CVD at baseline, including Black, White, Hispanic, and Chinese individuals (2000\u20132002). Using Cox proportional hazards modeling with time-updated covariates, we evaluated the association of self-reported race and ethnicity with all-cause and adjudicated CVD mortality, with progressive adjustments for age and sex, SES (neighborhood SES, income, education, and health insurance), lifestyle and psychosocial risk factors, clinical risk factors, and immigration history.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>During a median of 15.8 years of follow-up, 22.8% of participants (n=1552) died, of which 5.3% (n=364) died of CVD. After adjusting for age and sex, Black participants had a 34% higher mortality hazard (hazard ratio [HR], 1.34 [95% CI, 1.19\u20131.51]), Chinese participants had a 21% lower mortality hazard (HR, 0.79 [95% CI, 0.66\u20130.95]), and there was no mortality difference in Hispanic participants (HR, 0.99 [95% CI, 0.86\u20131.14]) compared with White participants. After adjusting for SES, the mortality HR for Black participants compared with White participants was reduced (HR, 1.16 [95% CI, 1.01\u20131.34]) but still statistically significant. With adjustment for SES, the mortality hazards for Chinese and Hispanic participants also decreased in comparison with White participants. After further adjustment for additional risk factors and immigration history, Hispanic participants (HR, 0.77 [95% CI, 0.63\u20130.94]) had a lower mortality risk than White participants, and hazard ratios for Black participants (HR, 1.08 [95% CI, 0.92\u20131.26]) and Chinese participants (HR, 0.81 [95% CI, 0.60\u20131.08]) were not significantly different from those of White participants. Similar trends were seen for CVD mortality, although the age- and sex-adjusted HR for CVD mortality for Black participants compared with White participants was greater than all-cause mortality (HR, 1.72 [95% CI, 1.34\u20132.21] compared with HR, 1.34 [95% CI, 1.19\u20131.51]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>These results highlight persistent racial and ethnic differences in overall and CVD mortality, largely attributable to social determinants of health, and support the need to identify and act on systemic factors that shape differences in health across racial and ethnic groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.122.059174","type":"journal-article","created":{"date-parts":[[2022,7,18]],"date-time":"2022-07-18T14:00:15Z","timestamp":1658152815000},"page":"229-239","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":153,"title":["Racial and Ethnic Differences in All-Cause and Cardiovascular Disease Mortality: The MESA Study"],"prefix":"10.1161","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8655-5204","authenticated-orcid":true,"given":"Wendy S.","family":"Post","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine (W.S.P., J.A.C.L.), Johns Hopkins University, Baltimore, MD."},{"name":"Department of Epidemiology, Bloomberg School of Public Health (W.S.P., M.S.), Johns Hopkins University, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3658-6165","authenticated-orcid":true,"given":"Karol E.","family":"Watson","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, UCLA, Los Angeles, CA (K.E.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spencer","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics (S.H., W.C.J., T.S.K., R.L.M.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2635-2699","authenticated-orcid":true,"given":"Aaron R.","family":"Folsom","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., J.S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moyses","family":"Szklo","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Bloomberg School of Public Health (W.S.P., M.S.), Johns Hopkins University, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7382-0603","authenticated-orcid":true,"given":"Steven","family":"Shea","sequence":"additional","affiliation":[{"name":"Department of Medicine, Vagelos College of Physicians &amp; Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (S.S., R.G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Graham","family":"Barr","sequence":"additional","affiliation":[{"name":"Department of Medicine, Vagelos College of Physicians &amp; Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (S.S., R.G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Burke","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences (G.B.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain G.","family":"Bertoni","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (A.G.B.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norrina","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Northwestern University, Chicago, IL (N.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7076-483X","authenticated-orcid":true,"given":"James S.","family":"Pankow","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F., J.S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8756-6995","authenticated-orcid":true,"given":"Joao A.C.","family":"Lima","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine (W.S.P., J.A.C.L.), Johns Hopkins University, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7191-1723","authenticated-orcid":true,"given":"Jerome I.","family":"Rotter","sequence":"additional","affiliation":[{"name":"The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA (J.I.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4174-9037","authenticated-orcid":true,"given":"Joel D.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Environmental &amp; Occupational Health Sciences (J.D.K.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3161-3753","authenticated-orcid":true,"given":"W. Craig","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Biostatistics (S.H., W.C.J., T.S.K., R.L.M.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9897-7076","authenticated-orcid":true,"given":"Richard A.","family":"Kronmal","sequence":"additional","affiliation":[{"name":"Department of Biostatistics (S.H., W.C.J., T.S.K., R.L.M.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana V.","family":"Diez-Roux","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA (A.V.D.-R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn L.","family":"McClelland","sequence":"additional","affiliation":[{"name":"Department of Biostatistics (S.H., W.C.J., T.S.K., R.L.M.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000950"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2015-205623"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2017.01.011"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000534"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000071"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03510200070034"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.21106\/ijma.236"},{"key":"e_1_3_3_9_2","unstructured":"Disparities HealthyPeople.gov. Accessed January 14 2022. https:\/\/www.healthypeople.gov\/2020\/about\/disparitiesAbout.aspx"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.10960"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-040218-043750"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwf113"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.002243"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwx047"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.530147"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2016.08.002"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.004815"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00378-0"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjhyper.2004.06.001"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/ajh.2010.200"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwn047"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.020534"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.706226"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0165651"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2016.08.004"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwn350"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2009.27597"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.192703"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(00)90301-6"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1037\/0882-7974.11.2.207"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.010603"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1177\/135910539700200305"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.2691"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2020.100634"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2013-202682"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2016.04.008"},{"key":"e_1_3_3_37_2","volume-title":"Multiple Regression in Behavioral Research","author":"Pedhazur EJ","year":"1997","unstructured":"Pedhazur, EJ. Multiple Regression in Behavioral Research. 3rd ed. Harcourt Brace; 1997.","edition":"3"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/biostatistics\/kxt050"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.025848"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.036553"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.019828"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfq676"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-015-0157-3"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-2182"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2007.123844"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjhyper.2006.09.025"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.14517"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000580"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.030426"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2016.09.002"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.122.059174","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T03:59:35Z","timestamp":1715572775000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.122.059174"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,19]]},"references-count":49,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,7,19]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.122.059174"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.122.059174","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.742242692.793594826","asserted-by":"object"}]},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,19]]},"assertion":[{"value":"2022-01-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}