All-Cause, Cardiovascular, and Stroke Mortality Among Foreign-Born Versus US-Born Individuals of African Ancestry

Abstract

BACKGROUND: Little is known about the effect of region of origin on all-cause mortality, cardiovascular mortality, and stroke mortality among Black individuals. We examined associations between nativity and mortality (all-cause, cardiovascular, and stroke) in Black individuals in the United States. METHODS AND RESULTS: Using the National Health Interview Service 2000 to 2014 data and mortality-linked files through 2015, we identified participants aged 25 to 74 years who self-identified as Black (n=64 717). Using a Cox regression model, we examined the association between nativity and all-cause, cardiovascular, and stroke mortality. We recorded 4329 deaths (205 stroke and 932 cardiovascular deaths). In the model adjusted for age and sex, compared with US-born Black individu-als, all-cause (hazard ratio [HR], 0.44 [95% CI, 0.37– 0.53]) and cardiovascular mortality (HR, 0.66 [95% CI, 0.44– 0.87]) rates were lower among Black individuals born in the Caribbean, South America, and Central America, but stroke mortality rates were similar (HR, 1.01 [95% CI, 0.52–1.94]). African-born Black individuals had lower all-cause mortality (HR, 0.43 [95% CI, 0.27– 0.69]) and lower cardiovascular mortality (HR, 0.42 [95% CI, 0.18– 0.98]) but comparable stroke mortality (HR, 0.48 [95% CI, 0.11– 2.05]). When the model was further adjusted for education, income, smoking, body mass index, hypertension, and diabetes, the difference in mortality between foreign-born Black individuals and US-born Black individuals was no longer significant. Time since migration did not significantly affect mortality outcomes among foreign-born Black individuals. CONCLUSIONS: In the United States, foreign-born Black individuals had lower all-cause mortality, a difference that was ob-served in recent and well-established immigrants. Foreign-born Black people had age-and sex-adjusted lower cardiovascular mortality than US-born Black people.