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Heart Disease Death Rates among Women Vary Dramatically by State and Race, Find University of Pittsburgh Researchers

PITTSBURGH, July 3, 2000 — Striking differences in heart disease death rates exist among American women based on race and geographical location, according to a study by researchers at the University of Pittsburgh Graduate School of Public Health (GSPH). Results of the study appear in the June issue of the Journal of Women’s Health & Gender-Based Medicine.

Comparing the highest and lowest rates across racial and geographical categories, investigators found a stunning seven-fold difference in mortality from coronary heart disease (CHD) among American women aged 45 to 54 -- 125 deaths per 100,000 black women in Arkansas vs. 17 deaths per 100,000 white women in Colorado.

"Coronary heart disease is the leading cause of death among women in the United States," said Akira Sekikawa, M.D., M.P.H., Ph.D., research fellow and principal investigator of the study. "This is the first study to focus on how geographic and racial differences affect heart disease mortality among women in the 45-to-54 age bracket – a critical time when women experience many physiological changes that can ultimately affect the heart."

The findings could be instrumental in helping public health practitioners target populations that are at particular risk for heart disease.

"Knowing which groups of women are the most vulnerable to death from heart disease, we can better focus programs that help women stop smoking and control obesity, high cholesterol and high blood pressure," Dr. Sekikawa explained.

Using information available on mortality rates from coronary heart disease (International Classification of Diseases 9th revision, codes 410-414, and 429.2) among women aged 45-54 in the United States in 1994, researchers found that across the board, black women exhibited rates that were nearly three times those of white women. In addition, overall mortality rates were highest in the deep south and lowest in western and eastern states.

For black women, mortality rates for CHD were highest in Arkansas (124/100,000), Louisiana (113/100,000) and Pennsylvania (108/100,000), and lowest in New Jersey (45/100,000), Maryland (49/100,000) and Georgia (57/100,000). For white women, rates were highest in Louisiana (55/100,000), Mississippi (53/100,000) and Oklahoma (50/100,000), and lowest in Minnesota (22/100,000), Washington (18/100,000) and Colorado (17/100,000).

"The absolute magnitude of the differences in mortality from CHD between black and white women is intriguing," said Lewis Kuller, M.D., Dr.P.H., professor of epidemiology and co-author of the study. "The gap between the highest and lowest rates in the U.S. is larger than the gap between countries with the highest [Trinidad] and lowest [Japan] mortality rates for the same diseases."

Investigators found that CHD mortality in white women was moderately linked to cigarette smoking and lower education levels.

"While there are limitations to the evaluation of existing research data on cigarette smoking and educational attainment, it is likely that smoking and variations in education levels account for variations in mortality from CHD among women aged 45 to 54," Dr. Kuller said.

Mortality data for the study was provided by the Centers for Disease Control and Prevention (CDCP) and the World Health Organization. CDCP data were available on CHD mortality for 36 states for white women and for 20 states for black women. Data on educational attainment were provided by the U.S. Bureau of the Census and were available only for the largest 25 states. Data on cigarette smoking came from the Behavioral Risk Factor Surveillance System, a survey that gathers information on health behaviors that relate to the leading causes of death among adults in the U.S. This information was available for all states except Rhode Island.

Established in 1948, the GSPH at the University of Pittsburgh is world-renowned for contributions that have influenced public health practices and medical care for millions of people. It is the only fully accredited school of public health in the Commonwealth of Pennsylvania and is one of the top-ranked schools of public health in the United States.

For more information about the GSPH at the University of Pittsburgh, access the school’s website at

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