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Mac W. Otten, Jr, MD, MPH; Steven M. Teutsch, MD, MPH; David F. Williamson, MS, PhD; James S. Marks, MD, MPH

JAMA. 1990;263(6):845-850.

Abstract
We compared the mortality rate ratios, before and after adjustment for different risk factors, of black vs white adults in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. For persons 35 to 54 years old, the rate ratio of mortality for blacks vs whites decreased from 2.3 (unadjusted) to 1.9 when adjusted simultaneously for six well-established risk factors (smoking, systolic blood pressure, cholesterol level, body-mass index, alcohol intake, and diabetes) and decreased from 1.9 to 1.4 when adjusted for the six risk factors plus family income. Thus, approximately 31% of the excess mortality can be accounted for by six well-established risk factors and a further 38% by family income. This leaves 31% unexplained. Broader social and health system changes and research targeted at the causes of the mortality gap, coupled with increased efforts aimed at modifiable risk factors, may all be needed for egalitarian goals in health to be realized.

(JAMA. 1990;263:845-850)

Author Affiliations
From the Epidemiology Program Office (Drs Otten and Teutsch) and the Division of Nutrition (Dr Williamson) and Office of the Director (Dr Marks), Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Atlanta, Ga.

Footnotes
Reprint requests to Division of STD/HIV Prevention, Mailstop E02, Centers for Disease Control, Atlanta, GA 30333 (Dr Otten).

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