Despite strong decreases in coronary heart disease (CHD) mortality over past decades, there is evidence that racial and socioeconomic disparities in CHD mortality are increasing. CHD surveillance efforts that examine trends within these population subgroups are an important first step in quantifying and reducing disparities. Yet, only one U.S. population-based CHD surveillance study includes black populations and none has monitored trends by socioeconomic status (SES). The Atherosclerosis Risk in Communities (ARIC) Study has monitored rates and trends in validated hospitalized myocardial infarction and fatal CHD among black and white adults aged 35 to 74 years in four U.S. communities since 1989. The proposed study will expand the scope of ARIC surveillance by examining variations in the rates and temporal trends in CHD by SES, measured at the level of census tract. For CHD events already included in ARIC surveillance (1992- 2002), addresses will be obtained from medical records and death certificates and geocoded so that they can be matched with identifiers for census based geographical areas. The ARIC study will contribute yearly updates of abstracted CHD events and addresses for subsequent years (2003-2005). Each event will be linked with census tract level SES indicators available from the 1990 and 2000 censuses. This novel effort will permit an examination of disparities by SES in rates and trends in fatal CHD, hospitalized myocardial infarction, case fatality, use of invasive cardiac procedures and prescription of efficacious medication at time of hospital discharge. In addition, the extent to which racial disparities in CHD and associated treatments are explained by SES will also be explored. This study would be the first U.S. population-based CHD surveillance study to include an assessment of variations in the burden of CHD by SES and thus, would provide valuable contributions to the scientific literature. Furthermore, the findings could be used to plan targeted public health interventions aimed at reducing CHD disparities. ? ?
