Evidence for a Black-White crossover in all-cause and coronary heart disease mortality in an older population: The North Carolina EPESE

Objectives. This cohort study evaluated racial differences in mortality among Blacks and Whites 65 years and older. Methods. A total of 4136 men and women (1875 Whites and 2261 Blacks) living in North Carolina were interviewed in 1986 and followed up for mortality until 1994. Hazard ratios (HRs) for all-cause and cause-specific mortality were calculated, with adjustment for sociodemographic and coronary heart disease (CHD) risk factors. Results. Black persons had higher mortality rates than Whites at young-old age (65-80 years) but had significantly lower mortality rates after age 80. Black persons age 80 or older had a significantly lower risk of all-cause mortality (HR of Blacks vs Whites, 0.75. 95% confidence interval [CI] = 0.62, 0.90) and of CHD mortality (HR 0.44; 95% CI = 0.30, 0.66). These differences were not observed for other causes of death. Conclusions. Racial differences in mortality are modified by age. This mortality crossover could be attributed to selective survival of the healthiest oldest Blacks or to other biomedical factors affecting longevity after age 80. Because the crossover was observed for CHD deaths only, age overreporting by Black older persons seems an unlikely explanation of the mortality differences.