The following are key points to remember from a JACC report card on excess cardiovascular (CV) mortality among Black Americans from 2000-2022:

1. This report presents the excess age-adjusted mortality rates (AAMR) and excess years of life lost (YPLL) from cardiovascular disease (CVD) and its leading components: ischemic heart disease (IHD), hypertension (HTN), cerebrovascular disease, and heart failure (HF).
2. The Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (WONDER) national death certificate data were used to collect primary cause of death data in 5-year age groups from non-Hispanic Black (Black) and non-Hispanic White (White) populations, ages 20-84 years. Race categories followed the National Center for Health Statistics (NCHS) guidance. International Classification of Diseases–10th Revision (ICD-10) codes were used for CVD and its components. Excess AAMR was computed by subtracting the estimated AAMR of White people from the AAMR of Black people. Excess YPLL was computed in a similar manner.
3. Overall CVD: Between 2000 and 2022, excess AAMR for overall CVD decreased from 164.8 to 95.1 per 100,000 until 2012, followed by an increase to 113.1 per 100,000 in 2020 and a return to the pre-pandemic level in the following 2 years in females. Similarly, excess AAMR decreased from 195 to 142 per 100,000 until 2011, followed by an increase in 2020 to 186.7 per 100,000 and a subsequent return to the pre-pandemic level in the following 2 years in males. There were an estimated 779,387 excess deaths and 23.7 million excess YPLL due to CVD among Black Americans relative to White Americans, including approximately 362,887 excess deaths and 11.2 million excess YPLL among Black females and about 416,500 excess deaths and 12.5 million excess YPLL among Black males.
4. IHD: Between 2000 and 2022, excess AAMR for IHD decreased from 72.7 to 28.2 per 100,000 until 2019, followed by an increase to 36.6 per 100,000 in 2020 and a return to the pre-pandemic level in the following 2 years for females. Similarly, excess AAMR decreased from 69.5 to 38.1 per 100,000 until 2019, followed by an increase to 53.9 per 100,000 in 2020 and a slight decrease, but not to the same level as the pre-pandemic level in the following 2 years in males. There were an estimated 257,327 excess deaths and 7.9 million excess YPLL due to IHD among Black Americans relative to White Americans, including approximately 129,940 excess deaths and 4.1 million excess YPLL among Black females and about 127,387 excess deaths and 3.8 million excess YPLL among Black males during this period.
5. HTN: Between 2000 and 2022, excess AAMR for HTN decreased from 32.2 to 24.1 per 100,000 until 2011, when it reached a relative plateau followed by an increase in 2020 and a return to the pre-pandemic trend in the following 2 years in females. Similarly, excess AAMR decreased from 42.2 to 28.8 until 2011, when it reached a plateau, followed by an increase in 2020 and a return to the pre-pandemic level in the following 2 years in males. There were an estimated 191,097 excess deaths and 5.8 million excess YPLL due to HTN among Black Americans relative to White Americans. Specifically, there were approximately 85,031 excess deaths and 2.6 million excess YPLL among Black females and about 106,066 excess deaths and 3.2 million excess YPLL among Black males during this period.
6. Cerebrovascular disease: Between 2000 and 2022, excess AAMR for cerebrovascular disease decreased from 30.2 to 18.3 per 100,000 until 2011, followed by an increase in 2020 and then a return to the pre-pandemic level in the following 2 years for females. Similarly, excess AAMR decreased from 45.2 to 30.2 per 100,000 until 2011, when it reached a plateau, followed by an increase in 2020 to 35.6 per 100,000 and a subsequent return to the pre-pandemic level in the following 2 years for males. There were an estimated 154,541 excess deaths and 4.7 million excess YPLL due to cerebrovascular disease among Black Americans relative to White Americans, including approximately 69,672 excess deaths and 2.1 million excess YPLL among Black females and about 84,869 excess deaths and 2.6 million excess YPLL among Black males during this period.
7. HF: Between 2000 and 2022, excess AAMR for overall HF increased from 5.7 to 8.0 per 100,000 in 2016, followed by an increase to 8.9 per 100,000 in 2020 for females. A return to the pre-pandemic level followed this increase, but the excess AAMR was still higher than the 2015 level for females in the following 2 years. Similarly, excess AAMR increased from 6.2 to 15.1 per 100,000 in 2020 and returned to 12.8 in 2021, followed by 13.9 in 2022 in males. There were an estimated 46,578 excess deaths and 1.3 million excess years of potential life lost due to HF among Black Americans relative to White Americans, including approximately 20,974 excess deaths and 625,604 excess YPLL among Black females and about 25,604 excess deaths, and 744,300 excess YPLL among Black males during this period.

Summary Points

• Between 2000 and 2022, Black Americans had almost 8,800,000 excess age-adjusted deaths and 24 million excess years of potential life lost due to CVD.
• Despite the reduction in CV morbidity and mortality over the last 50 years, those declines have evolved at racially disproportionate rates, resulting in not just health inequities but life inequities.
• Disparities were evident across different subcategories, including IHD, HTN, cerebrovascular disease, and HF. Sharp increases during the pandemic indicate the specific vulnerability of this group during a public health crisis and the need to mitigate this risk in future pandemics.

Clinical Topics: Prevention

Keywords: Healthcare Disparities, Race Factors, Social Determinants of Health

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