Heart disease connected to birthplace, social status Environment, not race, is main factor, study says


When it comes to dying of heart disease, where you were born and your status in society are more important than the color of your skin, researchers said yesterday.

Blacks have long been known to be more likely than whites to die from heart disease and strokes, and many researchers have attributed the disparity to racial differences.

But environmental factors -- including diet, smoking, lifestyle, poverty and even racism itself -- are more important in determining that risk than any inherent racial differences, according to two new studies published today in the New England Journal of Medicine.

One team studied heart-disease deaths among residents of New York City and found that blacks born in the northeastern United States were at no greater risk than whites, but were twice as likely to die from it as blacks born in the Caribbean. New York blacks who were born in the South, however, were twice as likely to die of heart disease as blacks or whites born in the Northeast.

"These are huge differences, much larger than we see with blood pressure or lipids," said Dr. Michael H. Alderman of the Albert Einstein College of Medicine, a co-author of the study.

Blacks who are born into the dietary and cultural patterns of the South and later move into the urban stress of New York have "the worst of all cardiovascular worlds," according to an editorial by Dr. Richard F. Gillum of the Centers for Disease Control and Prevention in the same journal. Researchers speculate that high-fat diets, smoking and alcohol use -- among other factors -- may be more common in the South.

The second study showed that blacks living in areas of high poverty, including the Watts area of Los Angeles and central Detroit, were at much greater risk of dying from all causes than blacks living in more affluent areas.

The two studies "point out the fact that we can't assume that all blacks are the same" in terms of cardiovascular risk, said Dr. Charles K. Francis of Harlem Hospital in New York.

"They suggest that cultural factors, diet, level of exercise and other factors may be as important as, or more important than, whether someone is black or white."

Unfortunately, added epidemiologist Paul Sorley of the National Heart, Lung and Blood Institute, "Nobody has the data to understand why this happening." Alderman and his colleagues studied heart attack deaths in New York, using death certificates to identify place of birth. Cardiovascular disease was the leading cause of death for both races.

"We did the relatively simple thing of dividing black residents of New York City into three roughly equal groups depending on where they were born, and we found tremendous differences in the likelihood of death," especially from heart attacks, Alderman said.

Overall, they found that male and female blacks born in the Caribbean and the Northeast had lower rates of death from coronary heart disease than did Northeastern-born whites. Only when blacks born in the South were added did blacks have a higher mortality rate from heart disease.

Pub Date: 11/21/96

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