BACKGROUND: Cardiovascular disease (CVD) is the second-leading cause of death in Minnesota and the CVD mortality rate among both whites and African Americans (AA) is the lowest of all states. Unlike in most other states, there is no persistently higher CVD mortality rate for African-Americans (AA) compared to whites in Minnesota. This may be due in part to the large recent immigration of African-born individuals into the state. In 2015, approximately one-third of AAs in Minnesota were foreign-born, with more than half from East Africa. The purpose of this work is to describe mortality due to CVD and plan better public health interventions for Minnesota’s diverse AA population.
METHODS: We obtained age-specific annual population estimates of AAs in Minnesota by US and foreign-born status from the State Demographer’s Office and mortality counts from the Minnesota Department of Health from 2001-2015. ICD-10 codes were used to categorize CVD deaths due to heart disease (HD) only, heart disease and stroke (HS), and major CVD. Crude age-group specific and age-adjusted mortality rates were calculated. Rate ratios were calculated by comparing age-adjusted and age-specific mortality rates between US-born and foreign-born AAs.
RESULTS: CVD mortality rates have declined for both US-born and foreign-born AAs since 2001. The age-adjusted annual HD mortality rate for 2001-2015 for ages 25 and up was significantly higher in US-born AAs (252.0 per 100,000; 95% CI: 240.4-263.5) compared to foreign-born AAs (54.7 per 100,000; 95% CI: 46.6-62.8), yielding a rate ratio of 4.6 (95% CI: 3.9-5.4). This is somewhat higher than the rate ratio for all-cause mortality (3.3; 95% CI: 3.1-3.5) during the same time period. In all ten-year age bands with at least twenty foreign-born AA deaths, the rate ratios of HD deaths for US-born compared to foreign-born AAs ranged from 3.5 to 5.3. Compared to whites, US-born AAs were more likely and foreign-born AAs less likely to die of HD. These patterns persisted in HS and major CVD mortality rates.
CONCLUSIONS: Extremely large disparities were seen in CVD mortality rates between US-born and foreign-born AAs in Minnesota during 2001-2015. This disparity has remained relatively constant over time, and may contribute to the lack of a persistent difference in age-adjusted CVD mortality rates between whites and AAs in Minnesota. Differences between US-born AAs and whites were more consistent with patterns observed in other states. These results highlight the need for targeted interventions in Minnesota’s AA communities, specifically by US-born and foreign-born status.