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Place of Birth More Important Than Race in Blacks’ Heart Disease

November 21, 1996

BOSTON (AP) _ Blacks are more likely than whites to die of cardiovascular disease because so many of them are born in the South, not because of their race, a study concludes.

Experts have long noticed that black Americans suffer more diseases of the circulatory system _ mainly heart attacks, strokes and high blood pressure _ than do whites.

They assumed that racial differences in genetic susceptibility to disease, in eating and living habits and perhaps in access to health care accounted for this. The new study challenges some of these long-held ideas.

It found that when broken down by birthplace, blacks differ far more from each other than they do from whites.

Among New Yorkers born in the Northeast, blacks and whites have nearly identical risks of these ills. However, black New Yorkers who were born in the South have a sharply higher risk, and black New Yorkers born in the Caribbean have a significantly lower risk.

``By looking at race in health outcomes and cardiovascular disease, we really obscure more than we reveal. There are other facts about people that are much more important,″ said Dr. Michael H. Alderman, a co-author of the study. He is chairman of epidemiology and social medicine at Albert Einstein College of Medicine in New York City.

The life expectancy of black people in the United States is lower than that of whites. More cardiovascular disease _ the leading cause of death for all Americans _ is the single most important reason.

The latest study, based on New York City death records from 1988 through 1992 and 1990 census data, was published in today’s issue of the New England Journal of Medicine.

``Southern-born blacks are responsible for the excess mortality among blacks,″ Alderman said.

The researchers believe Southern-born white people also have more cardiovascular disease than white Northerners. However, this study could not measure that, since not enough whites from the South live in New York City to draw an accurate comparison.

Just why black New Yorkers born in the South have such an increased risk is unclear, although Alderman speculated that it probably has to do with eating habits learned early in life.

An editorial by Dr. Richard F. Gillum of the Centers for Disease Control and Prevention speculated that the Southern lifestyle, smoking, a high-fat diet and urban stress combine ``to produce the worst of all cardiovascular worlds.″

The differences were apparent for both sexes but starkest among men between 25 and 44, when these diseases are relatively uncommon. In this age group, Southern-born New York blacks were 30 percent more likely than New York blacks born in the Northeast to die from heart disease, and their risk was four times greater than that of Caribbean-born black New Yorkers.

Among New Yorkers of all ages born in the Northeast, the risk was nearly the same for blacks and whites. There were 285 cardiovascular deaths for every 100,000 white men and 299 for blacks. Among women, there were 155 deaths for whites and 165 for blacks.

A separate study in the journal looked at deaths from all causes in 16 areas across the United States. It found striking differences for both blacks and whites, depending on where they lived.

The researchers, led by Arline T. Geronimus of the University of Michigan, found that among poor black areas studied, the so-called Black Belt in Alabama had the lowest mortality, even though it had the highest poverty rate, and Harlem in New York City had the highest mortality and the lowest poverty rate.

A widely quoted study in 1980 found that black men living in Harlem had less chance of surviving to age 65 than did men in Bangladesh. The new report found that since then, the outlook for Harlem men has actually gotten worse.

However, by comparison, blacks living elsewhere in New York City _ in Queens and the Bronx _ were found to have a mortality rate that was only slightly higher than the national average for whites.