HYPERTENSIVE VASCULAR-DISEASE AS A CAUSE OF DEATH IN BLACKS VERSUS WHITES - AUTOPSY FINDINGS IN 587 ADULTS

Cardiovascular disease is the major cause of excess mortality among ur ban US blacks, but autopsy data comparing black-white differences in u nderlying pathological causes of cardiovascular death are lacking. We reviewed all 720 adult cases autopsied in 1991 in the New York City Me dical Examiner's Office in which the coded cause of death was cardiova scular disease (International Classification of Diseases, 9th Revision , codes 391, 393 to 398, 401 to 404, 410, 411, 414 to 417, 420 to 438, and 440 to 444). After exclusion of 133 cases because race was missin g or coded as other than black or white, gender was not coded, or ther e was an unusual circumstances of death or extreme obesity, 587 cases were available for analysis. There were 314 black and 273 white subjec ts, Black women were younger than white women at time of death (mean a ge, 54.7 versus 61.5 years; P<.001), whereas black and white men did n ot differ in mean age at death. Hypertensive vascular disease was the autopsy cause of death in 42% of blacks compared with 23% of whites (P <.001). Conversely, atherosclerotic heart disease was the autopsy caus e of death in 64% of white subjects but only 38% of blacks. These patt erns were consistent in both sexes and after adjustment for age. Hyper tensive vascular disease was far more common than atherosclerotic hear t disease as the cause of death at autopsy among blacks compared with whites in New York City, whereas atherosclerotic heart disease was mor e common in whites. These findings suggest that ineffective control of hypertension is a major factor contributing to excess cardiovascular mortality among urban blacks.