DEMOGRAPHIC CHARACTERISTICS AFFECTING RISK FOR HEART ATTACK

Coronary heart disease mortality rates rise exponentially with age for men and women . Until the seventh decade of life, African-American men have the highest rates of CHD mortality, followed by white men, African-American women, and white women. The rates in men converge at approximately the seventh decade, and those in women converge in the ninth decade. Further data about CHD rates by race/ethnicity come from analysis of death rates in California from 1985 to 1990. The CHD death rates per 100,000 population were as follows: white women, 143; white men, 302; Hispanic women, 97; Hispanic men, 175; African-American women, 214; African-American men, 316; Chinese women, 73; Chinese men, 155; Japanese women, 67; Japanese men, 146; Asian Indian women, 110; and Asian Indian men 258. Thus, within all groups, CHD rates are lower in women than in men, although African-American women have CHD death rates far exceeding those for women in other groups. The reasons behind these differences in rates have not been well studied and are poorly understood.
Lower socioeconomic status and low income are associated with increased CHD mortality in men and women, probably due in part to the higher prevalence of CHD risk factors among those of lower socioeconomic status. Perceived financial status is also associated with MI and coronary death in women. Higher systolic blood pressure, higher low-density lipoprotein (LDL) cholesterol, higher fasting glucose levels and 2-hour insulin values, higher body mass index (BMI), and lower high-density lipoprotein (HDL) cholesterol are all associated with lower socioeconomic status. Educational attainment, which often determines socioeconomic status, is inversely related to CHD risk in African-American and white women and white men, but is positively associated with CHD in African-American men. Women of lower educational attainment are more often smokers, sedentary, angry, pessimistic, depressed, and dissatisfied with their work, and have less social support and self-esteem. Educational incongruity with the spouse is associated with increased risk of sudden cardiac death and MI in women. Among men, the 10-year incidence of CHD increases with the wife's education level for those whose wives are employed outside the home, but not for those whose wives are homemakers.