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 individuals, 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 observed in recent and well‐established immigrants. Foreign‐born Black people had age‐ and sex‐adjusted lower cardiovascular mortality than US‐born Black people.