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African American women, cardiovascular disease risk factors, socioeconomic status



  1. Appel, Susan J.
  2. Harrell, Joanne S.
  3. Deng, Shibing


Background: African American women living in the Southeast experience a higher mortality due to cardiovascular (CV) disease than their White counterparts. It is unclear if this vulnerability to CV disease is due to race, socioeconomic status, or health behaviors.


Objectives: To examine the disparities in cardiovascular health between Southern rural, African American and White women to determine if a CV Risk-Index differed by race, education, or income levels and if differences persisted when controlling for body mass index (BMI).


Methods: Subjects were 1,110 women (27% African American, 73% White) residing in rural North Carolina. Data were collected by mailed questionnaire and analyzed using analysis of variance (ANOVA) and analysis of covariance (ANCOVA).


Results: African American women had significantly lower education and lower income than Whites, higher BMI, and a much greater prevalence of hypertension, angina, and diabetes. In a three-way ANOVA including race, income, and education, education and race were significant predictors of the CV Risk Index, but when adjusted for BMI race was no longer significant (p = .3039); the only significant predictors were BMI and educational level.


Discussion: Women with the least education had the highest CV Risk-Index, regardless of race. These findings suggest the need to focus risk reduction interventions on all Southern rural women with limited education, not only African American women. This supports the current literature that suggests race should be viewed as a risk marker rather than a risk factor.