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Community Structure and Cardiovascular Mortality Trends

This study has been completed.
National Heart, Lung, and Blood Institute (NHLBI)
Information provided by:
University of North Carolina, Chapel Hill Identifier:
First received: May 25, 2000
Last updated: February 4, 2016
Last verified: February 2016
To assess the relationship of community socioeconomic (SE) structure to cardiovascular disease and all-cause mortality trends in the United States.

Cardiovascular Diseases Heart Diseases Myocardial Ischemia Cerebrovascular Disorders Cerebrovascular Accident

Study Type: Observational
Official Title: Community Structure and Cardiovascular Mortality Trends

Further study details as provided by University of North Carolina, Chapel Hill:

Study Start Date: June 1989
Study Completion Date: May 1993
Primary Completion Date: May 1993 (Final data collection date for primary outcome measure)
Detailed Description:


Socioeconomic structure refers to aspects of communities -- their industries, physical resources, occupational and income distributions -- that create the conditions for change in health-related exposures, behaviors, and availability of quality medical care. Preliminary studies suggest growing inequalities in ischemic heart disease mortality in communities at different levels of socioeconomic structure that probably reflect both differences in timing of onset of decline and rate of decline of mortality. Despite the beginning of a national decline of ischemic heart disease mortality for white men in the middle 1960's, some communities only began the decline some years later, at which time the national decline accelerated. Late declining communities were more likely to be nonmetropolitan and in the South. Further analyses showed that the onset of decline was strongly related to measures of socioeconomic structure, and that income-related characteristics could account for much of the previously observed metropolitan differential. Another study showed that the decline of ischemic heart disease in both white men and women has been greater in county groups with occupational structures characterized by higher levels of white collar employment. The trend toward greater relative geographic inequality of mortality appears to be stronger for ischemic heart disease than for stroke, all cardiovascular disease or all-cause mortality. Prevention strategies should take account of these processes not only to achieve a more equitable distribution of health but to target populations with the greatest excess risk available for reduction.


Several analyses were conducted using mortality data from the National Center for Health Statistics and population and socioeconomic data from the Census Bureau. The onset of decline of ischemic heart disease in white women and Black men was analyzed in relation to geographic region, metropolitan status, and socioeconomic structure. The association between onset of decline of ischemic heart disease and its rate of decline was studied. The relationship of occupational structure and other aspects of socioeconomic structure to the rate of decline of ischemic heart disease mortality in Blacks and whites was quantified by age. Geographic variations in levels and trends of stroke mortality were described in relation to socioeconomic structure. The associations of socioeconomic structure, cardiovascular disease risk factors, blood pressure treatment, and mortality were quantified in geographic areas sampled in the National Health and Nutrition Examination Survey (NHANES). Socioeconomic structure-mortality trend associations for ischemic heart disease and stroke were compared to associations for all cardiovascular disease, all-cause and non-specific causes. A detailed analysis was made of socioeconomic structure-mortality associations in the United States South with special attention to impact on Black/white mortality differentials.


Ages Eligible for Study:   up to 100 Years   (Child, Adult, Senior)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
No eligibility criteria
  Contacts and Locations
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Please refer to this study by its identifier: NCT00005245

Sponsors and Collaborators
University of North Carolina, Chapel Hill
National Heart, Lung, and Blood Institute (NHLBI)
Principal Investigator: Steven Wing University of North Carolina, Chapel Hill
  More Information

Publications: Identifier: NCT00005245     History of Changes
Other Study ID Numbers: 1126
R01HL042320 ( U.S. NIH Grant/Contract )
Study First Received: May 25, 2000
Last Updated: February 4, 2016

Additional relevant MeSH terms:
Cardiovascular Diseases
Heart Diseases
Myocardial Ischemia
Coronary Artery Disease
Cerebrovascular Disorders
Pathologic Processes
Vascular Diseases
Coronary Disease
Arterial Occlusive Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases processed this record on August 23, 2017