Since 1989, there has been a divergence in coronary heart disease (CHD) mortality rates for blacks and whites. “In 1980, white men had mortality rates 11 percent higher than those of black men;” however, “rates were 139.7 for whites and 144.5 for blacks in 1991.” Black women had higher reported rates than white women throughout, but the “absolute gap steadily increased from 1980 (+18.7) to 1991 (+21.9), an increase in relative difference from 19 to 33 percent.” The investigators estimated the associated excess CHD deaths for 5 years since 1987, comparing actual number of deaths with the number if a decline in mortality rates for blacks had been equal to that of whites. They found that “there were an estimated 4,000 excess CHD deaths of black men in 1991 alone due to the slower decline of mortality among blacks. The sum of the 5-year excess CHD deaths from 1987 to 1991 exceeded 14,300.”

When considering possible explanations, the authors suggest access to care may be an explanation and also note that, as evidenced in other studies, “blacks are half as likely to undergo angiography with a comparable CHD diagnosis, and half as likely to have bypass surgery with similar angiographic findings.” They conclude that “the factors that have led to the decline in CHD have not influenced all demographic groups equally over the last decade,” specifically “the potential benefits of the major public health advances achieved against the coronary epidemic has not been realized among blacks as much as it has among whites.”