Changing rate orders of race-gender heart disease death rates: An exploration of county-level race-gender disparities

A holistic view of racial and gender disparities that simultaneously compares multiple groups can suggest associated underlying contextual factors. Therefore, to more comprehensively understand temporal changes in combined racial and gender disparities, we examine variations in the orders of county-level race-gender specific heart disease death rates by age group from 1973–2015. We estimated county-level heart disease death rates by race, gender, and age group (35–44, 45–54, 55–64, 65–74, 75–84, ≥ 85, and ≥ 35) from the National Vital Statistics System of the National Center for Health Statistics from 1973–2015. We then ordered these rates from lowest to highest for each county and year. The predominant national rate order (i.e., white women (WW) < black women (BW) < white men (WM) < black men (BM)) was most common in younger age groups. Inverted rates for black women and white men (WW
Highlights • Combined racial and gender disparities can suggest underlying contextual factors. • We examined counties’ rate orders of race-gender specific heart disease mortality. • Many counties experienced rate orders that were not observed nationally. • Many counties had higher rates for black women than white men. • Socioeconomic forces may drive heart disease mortality more than biology.