Increasing Burden of Heart Failure in Black Adults in the US: 1999-2016

Abstract

BackgroundGiven increasing rates of heart failure (HF) risk factors (e.g. obesity, diabetes) that disproportionally affect black adults, we sought to describe contemporary trends in HF prevalence and examine differences between blacks and whites.HypothesisRacial disparities in HF exist and are widening.MethodsNon-pregnant adults aged ≥35 years who identified as non-Hispanic black or white from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016 were included. Age-adjusted HF prevalence was calculated by two-year cycles and weighted linear regression was used to examine trends over time. Odds ratios (OR) and 95% confidence intervals (CI) of HF in blacks vs. whites were calculated by pooling cycles into six-year periods with adjustment for age, sex, cardiovascular risk factors (CV RF), renal function, and proxies of socioeconomic status (SES: education level and health insurance status). Given a significant interaction between race and age group, analyses were stratified by age groups: 35-64 and 65+ years.ResultsOf 20,290 participants with mean age 55.3±0.2 years, 52% were women and 12% black. Age-adjusted prevalence of HF per 100,000 increased linearly among blacks from 3921 (2663, 5178) in 1999-2000 to 6568 (4557, 8580) in 2015-2016 (p-trend<0.05). Overall prevalence of HF per 100,000 was stable among whites between 1999 (3770 [3090, 4451]) and 2016 (3090 [2572, 3706], p-trend>0.05). Age and sex-adjusted odds of HF in blacks compared to whites (TABLE) was higher between 2005-10 (period 2) and 2011-16 (period 3). After adjustment for RF and SES, odds of HF remained higher in blacks in periods 2 and 3 by 1.51 (1.11, 2.04) and 1.55 (1.16, 2.06), respectively. This appeared to be primarily driven by differences in HF prevalence between younger blacks and whites (age 35-64 years).ConclusionsThe prevalence of HF in blacks is increasing and the odds of HF was significantly higher in blacks compared to whites. While the increased odds of HF was attenuated after adjusting for RF and SES, disparities persisted and have widened over time. Research and resources aimed at identifying social determinants of HF, alongside aggressive management of risk factors, are needed to prevent HF and reduce disparities. Given increasing rates of heart failure (HF) risk factors (e.g. obesity, diabetes) that disproportionally affect black adults, we sought to describe contemporary trends in HF prevalence and examine differences between blacks and whites. Racial disparities in HF exist and are widening. Non-pregnant adults aged ≥35 years who identified as non-Hispanic black or white from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016 were included. Age-adjusted HF prevalence was calculated by two-year cycles and weighted linear regression was used to examine trends over time. Odds ratios (OR) and 95% confidence intervals (CI) of HF in blacks vs. whites were calculated by pooling cycles into six-year periods with adjustment for age, sex, cardiovascular risk factors (CV RF), renal function, and proxies of socioeconomic status (SES: education level and health insurance status). Given a significant interaction between race and age group, analyses were stratified by age groups: 35-64 and 65+ years. Of 20,290 participants with mean age 55.3±0.2 years, 52% were women and 12% black. Age-adjusted prevalence of HF per 100,000 increased linearly among blacks from 3921 (2663, 5178) in 1999-2000 to 6568 (4557, 8580) in 2015-2016 (p-trend<0.05). Overall prevalence of HF per 100,000 was stable among whites between 1999 (3770 [3090, 4451]) and 2016 (3090 [2572, 3706], p-trend>0.05). Age and sex-adjusted odds of HF in blacks compared to whites (TABLE) was higher between 2005-10 (period 2) and 2011-16 (period 3). After adjustment for RF and SES, odds of HF remained higher in blacks in periods 2 and 3 by 1.51 (1.11, 2.04) and 1.55 (1.16, 2.06), respectively. This appeared to be primarily driven by differences in HF prevalence between younger blacks and whites (age 35-64 years). The prevalence of HF in blacks is increasing and the odds of HF was significantly higher in blacks compared to whites. While the increased odds of HF was attenuated after adjusting for RF and SES, disparities persisted and have widened over time. Research and resources aimed at identifying social determinants of HF, alongside aggressive management of risk factors, are needed to prevent HF and reduce disparities.