URBANIZATION AND CORONARY HEART-DISEASE MORTALITY AMONG AFRICAN-AMERICANS IN THE US SOUTH

Study objective - Despite significant declines since the late 1960s, c oronary moratality remains the leading cause of death for African Amer icans. African Americans in the US South suffer higher rates of cardio vascular disease than African Americans in other regions; yet the mort ality experiences of rural-dwelling African Americans, most of whom li ve in the South, have nor been described in detail. This study examine d. urban-rural, differentials in coronary mortality trends among Afric an Americans for the period 1968-86. Setting - The United States South , comprising 16 states and the District of Columbia. Study Population - African American men and women aged 35-74 years. Design - Analysis o f urban-rural differentials in temporal trends in coronary mortality f or a 19 year study period. All counties in the US South were grouped i nto five categories: greater metropolitan, lesser metropolitan, adjace nt to metropolitan, semirural, and isolated rural. Annual age adjusted mortality rates were calculated for each urban status group. In 1968, observed excesses in coronary mortality were 29% for men and 45% for women, compared with isolated rural areas. Metropolitan areas experien ced greater declines in mortality than rural areas, so by 1986 the urb an-rural differentials in coronary mortality were 3% for men and 11% f or women. Conclusions - Harsh living conditions in rural areas of the South precluded important coronary risk factors and contributed to low er mortality rates compared with urban areas during the 196Os. The dra matic transformation from an agriculturally based economy to manufactu ring and services employment over the course of the study period contr ibuted to improved living conditions which promoted coronary mortality declines in all areas of the South; however, the most favourable econ omic and mortality trends occurred in metropolitan areas.