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Representativeness of Medicare Participants in the Jackson Heart Study for African American Medicare Beneficiaries

Parikh, Kishan S.a,b; Greiner, Melissa A.a; Wang, Weic; Min, Yuan-Id; Correa, Adolfod,e; Banahan, Benjamin F.f; Curtis, Lesley H.a,b; Hernandez, Adrian F.a,b; O’Brien, Emily C.a,b; Mentz, Robert J.a,b

doi: 10.1097/EDE.0000000000000689
Validation Studies

Background: The Jackson Heart Study (JHS) assesses cardiovascular disease risk factors among African Americans in Jackson, Mississippi. Whether characteristics of JHS participants differ from those of a broader African American population are unknown.

Methods: In a retrospective observational analysis, we compared characteristics and outcomes of JHS participants 65 years old and older and enrolled in Medicare (n = 1,105) to regional (n = 57,489) and national (n = 95,494) cohorts of African American Medicare beneficiaries. We weighted the regional and national cohorts to match the age and sex distributions of the JHS–Medicare cohort for pairwise baseline comparisons. Outcomes of interest included mortality and Medicare costs. We used Cox proportional hazards models to test associations between cohorts and outcomes.

Results: The JHS–Medicare cohort was younger, included more women, and had fewer beneficiaries with dual Medicare–Medicaid eligibility, compared with regional and national Medicare cohorts. The cohort also had lower risks of stroke, lung disease, heart failure, diabetes, and renal disease. Mean Medicare costs were lower ($5,066 [SD = $11,932]) than in the regional ($7,419 [SD = $17,574]) and national ($8,013 [SD = $19,378]) cohorts. The regional and national cohorts had higher mortality (adjusted hazard ratios = 1.52; 95% confidence interval [CI] = 1.31, 1.76; and 1.49; 95% CI = 1.29, 1.73, respectively). Subgroup analysis for dual Medicare–Medicaid eligibility attenuated mortality differences.

Conclusion: JHS–Medicare participants had fewer comorbid conditions, better survival, and lower Medicare costs compared with regional and national cohorts. Observed differences may reflect healthy volunteer bias and higher socioeconomic status.

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From the aDuke Clinical Research Institute, Duke University School of Medicine, Durham, NC; bDepartment of Medicine, Duke University School of Medicine, Durham, NC; cCenter of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS; dDepartment of Medicine, University of Mississippi School of Medicine, Jackson, MS; eDepartment of Pediatrics, University of Mississippi School of Medicine, Jackson, MS; and fDepartment of Pharmacy Administration, University of Mississippi School of Pharmacy, Jackson, MS.

Submitted 19 September 2016; accepted 22 May 2017.

K.S.P. and R.J.M. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

The Jackson Heart Study cohort data are available to researchers who request it through the Jackson Heart Study Coordinating Center.

The Jackson Heart Study is supported by contracts HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C, and HHSN268201300050C from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities. Research reported in this manuscript was supported by grant R01HL117305 from the National Heart, Lung, and Blood Institute and grant 5T32GM086330-05 from the National Institutes of Health. The funding agencies were not directly involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

A.F.H. reported receiving research support from Amgen, Bayer, Bristol-Myers Squibb, GlaxoSmithKline, Merck, and Portola Pharmaceuticals; and serving on advisory boards for Amgen, AstraZeneca, Bayer, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Ortho-McNeil-Janssen, Pfizer, Pluristem, Sensible, and MyoKardia. E.C.O. reported receiving research support from Bristol-Myers Squibb, GlaxoSmithKline, Janssen Scientific, Novartis, and Pfizer; and serving on an advisory board for Portola Pharmaceuticals. R.J.M. reported receiving research support from Amgen, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Gilead, Novartis, Otsuka, and ResMed; receiving honoraria from HeartWare, Janssen, Luitpold Pharmaceuticals, Novartis, ResMed, and Thoratec; and serving on an advisory board for Luitpold Pharmaceuticals, Inc.

The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the US Department of Health and Human Services.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (

Correspondence: Kishan S. Parikh, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail:

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