Why are Black adults at greater risk of death from heart disease?
[Aug. 15, 2023: Staff Writer, The Brighter Side of News]
A breakthrough study discovered a persistent racial disparity in cardiovascular disease mortality among Black and White Americans. (CREDIT: Creative Commons)
In the ever-evolving landscape of public health, a breakthrough study discovered a persistent racial disparity in cardiovascular disease mortality among Black and White Americans. As the country records an overall decrease in cardiovascular disease deaths, Black Americans still face a 54% higher risk compared to their White counterparts. The root cause, as the new research suggests, is less about physiological markers and more about societal ones.
For years, public health professionals have ardently sought ways to reduce cardiovascular diseases, turning their attention to familiar culprits: smoking, obesity, lack of physical activity, high cholesterol, hypertension, and more. These factors, while instrumental in the health narrative, don't entirely account for the racial disparity that persists. A groundbreaking study from Tulane University might just hold the answer.
The research, published in the esteemed Annals of Internal Medicine, proffers that the racial divide in cardiovascular disease mortality between Black and White Americans can be attributed primarily to social determinants like unemployment, limited income, and absence of a supportive partner, rather than just the commonly cited medical risk factors.
Dr. Jiang He, the spearhead of the study and the Joseph S. Copes Chair in Epidemiology at Tulane’s School of Public Health and Tropical Medicine, expressed his surprise at the findings: “For so many years we have focused on known factors for cardiovascular disease prevention. But it surprised me that the Black-White difference in cardiovascular disease mortality is mainly due to social factors.”
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Leveraging health data of over 50,000 adults, researchers meticulously assessed the relationship between:
Clinical risk factors such as obesity, diabetes, hypertension, and high cholesterol.
Lifestyle risk factors like smoking, unhealthy dietary habits, sedentary lifestyles, and irregular sleep patterns.
And, most pivotally, social risk factors including unemployment, lower family income, food insecurity, subpar education, inconsistent access to healthcare, lack of private health insurance, non-homeownership, and single marital status, in relation to cardiovascular mortality.
Initial evaluations revealed that Black adults had a cardiovascular disease mortality rate 54% higher than White adults, after accounting for age and sex. Adjustments for clinical and lifestyle factors slightly mitigated this difference to 34% and 31% respectively. However, the game-changer came when adjusting for social risk factors: the racial disparity completely evaporated.
Among population subgroups, the age- and sex-standardized rate of cardio-vascular disease (CVD) mortality was:
484.7 (95% CI, 397.3-599.1) deaths per 100,000 person-years in Black participants;
384.5 (95% CI, 338.3-441.6) deaths per 100,000 person-years in white participants;
292.4 (95% CI, 217.8-402.7) deaths per 100,000 person-years in Hispanic participants;
255.1 (95% CI, 143.0-510.2) deaths per 100,000 person-years in other racial and ethnic groups.
Before adjustments, the HR in CVD mortality of Black participants compared with white individuals was 1.54 (95% CI, 1.34-1.77). Researchers noted that the HR decreased to:
1.34 (95% CI, 1.16-1.55) after adjustment for metabolic risk factors;
1.31 (95% CI, 1.15-1.5) after adjustment for behavioral risk factors; and
1.04 (95% CI, 0.9-1.21) after adjustment for social risk factors.
Note: Cardiac Index (CI) is a parameter of cardiac function reflecting not only left heart function but also right heart function. Furthermore, CI is a parameter related to both systolic and diastolic ventricular function.
“After adjusting for lifestyle and clinical risk factors, the Black-White disparity in cardiovascular disease mortality persisted, albeit at a reduced rate,” Dr. He elucidated. “Yet, upon adjusting for social risk factors, this racial difference completely disappeared.”
Social Determinants: The New Health Paradigm
Tulane’s recent endeavor is reminiscent of another of their studies which found that Black Americans had a 59% higher risk of premature death compared to White Americans. Astonishingly, the gap nullified after considering social determinants of health.
For those unfamiliar, the concept of 'social determinants of health', although novel, has gained traction lately, even receiving emphasis from the CDC’s Healthy People 2030 initiative. These determinants comprise eight pivotal areas in life, vital for health and well-being.
For Dr. He, this research accentuates the profound influence of socioeconomic factors on health. Secure employment, access to healthcare, and the support from families or communities play integral roles.
Jiang He, MD, PhD: Joseph S. Copes Chair and Professor of Epidemiology, Director of Tulane University Translational Science Institute. (CREDIT: Tulane University)
The Way Forward: From Research to Action
Capitalizing on these insights, Dr. He has embarked on a mission to bridge this health divide. He's initiating a program focused on mitigating hypertension among New Orleans' Black communities. The approach? Collaboration with local churches to offer health screening training and distribute free medications.
“It is essential to develop novel community-based interventions for reducing cardiovascular disease risk in Black populations,” Dr. He asserted.
While medical and lifestyle factors undoubtedly shape our health, the socio-economic scaffolding of one's life cannot be dismissed. To genuinely bridge health disparities, a holistic, all-encompassing approach addressing both medical and social aspects is imperative.
For more science and technology stories check out our New Discoveries section at The Brighter Side of News.
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