Background:Black adults experience a disproportionately higher burden of cardiovascular risk factors and disease in comparison with White adults in the United States. Less is known about how sex-based disparities in cardiovascular mortality between these groups have changed on a national scale over the past 20 years, particularly across geographic determinants of health and residential racial segregation.Methods:We used CDC WONDER (Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research) to identify Black and White adults age ≥25 years in the United States from 1999 to 2019. We calculated annual age-adjusted cardiovascular mortality rates (per 100 000) for Black and White women and men, as well as absolute rate differences and rate ratios to compare the mortality gap between these groups. We also examined patterns by US census region, rural versus urban residence, and degree of neighborhood segregation.Results:From 1999 to 2019, age-adjusted mortality rates declined overall for both Black and White adults. There was a decline in age-adjusted cardiovascular mortality among Black (602.1 to 351.8 per 100 000 population) and White women (447.0 to 267.5), and the absolute rate difference (ARD) between these groups decreased over time (1999: ARD, 155.1 [95% CI, 149.9–160.3]; 2019: ARD, 84.3 [95% CI, 81.2–87.4]). These patterns were similar for Black (824.1 to 526.3 per 100 000) and White men (637.5 to 396.0; 1999: ARD, 186.6 [95% CI, 178.6–194.6]; 2019: ARD, 130.3 [95% CI, 125.6–135.0]). Despite this progress, cardiovascular mortality in 2019 was higher for Black women (rate ratio, 1.32 [95% CI, 1.30–1.33])— especially in the younger (age <65 years) subgroup (rate ratio, 2.28 [95% CI, 2.23–2.32])—as well as for Black men (rate ratio, 1.33 [95% CI, 1.32–1.34]), compared with their respective White counterparts. There was regional variation in cardiovascular mortality patterns, and the Black-White gap differed across rural and urban areas. Cardiovascular mortality rates among Black women and men were consistently higher in communities with high levels of racial segregation compared with those with low to moderate levels.Conclusions:During the past 2 decades, age-adjusted cardiovascular mortality declined significantly for Black and White adults in the United States, as did the absolute difference in death rates between these groups. Despite this progress, Black women and men continue to experience higher cardiovascular mortality rates than their White counterparts.

中文翻译：

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1999 年至 2019 年美国黑人和白人成年人心血管死亡率的差异

背景：与美国的白人成年人相比，黑人成年人的心血管危险因素和疾病负担要高得多。过去 20 年，这些群体之间基于性别的心血管死亡率差异在全国范围内发生了怎样的变化，人们知之甚少，特别是在健康的地理决定因素和居住种族隔离方面。 方法：我们使用了 CDC WONDER（美国疾病控制与预防中心）预防流行病学研究的广泛在线数据），以确定 1999 年至 2019 年美国年龄≥25 岁的黑人和白人成年人。我们计算了黑人和白人女性和男性的年度年龄调整心血管死亡率（每 10 万人） ，以及绝对率差异和比率来比较这些组之间的死亡率差距。我们还研究了美国人口普查地区、农村与城市居住以及社区隔离程度的模式。结果：从 1999 年到 2019 年，黑人和白人成年人的年龄调整死亡率总体下降。黑人（每 10 万人中 602.1 例降至 351.8 例）和白人女性（每 10 万人中 447.0 例降至 267.5 例）的年龄调整心血管死亡率有所下降，并且这些群体之间的绝对率差（ARD）随着时间的推移而减小（1999 年：ARD，155.1 [95% CI，149.9–160.3]；2019 年：ARD，84.3 [95% CI，81.2–87.4]）。这些模式对于黑人（每 100 000 人 824.1 至 526.3）和白人（637.5 至 396.0）相似；1999 年：ARD，186.6 [95% CI，178.6-194.6]；2019 年：ARD，130.3 [95% CI，125.6-135.0 ]）。尽管取得了这一进展，2019 年黑人女性的心血管死亡率仍较高（比率为 1.32 [95% CI，1.30-1.33]），尤其是在较年轻（年龄 <65 岁）亚组中（比率为 2.28 [95% CI， 2.23–2.32]）——以及黑人男性（比率，1.33 [95% CI，1.32–1.34]），与相应的白人男性相比。心血管死亡率模式存在地区差异，农村和城市地区的黑人与白人之间的差距也不同。与低至中等种族隔离水平的社区相比，种族隔离程度较高的社区中黑人女性和男性的心血管死亡率始终较高。结论：在过去 20 年中，美国黑人和白人成年人的年龄调整心血管死亡率显着下降。美国，这些群体之间死亡率的绝对差异也是如此。尽管取得了这些进展，黑人女性和男性的心血管死亡率仍然高于白人。