TUESDAY, Oct. 5, 2021 (HealthDay News) — Black Americans have been consistently exposed to heart disease risk factors for the past 20 years — and social problems like unemployment and low incomes are causing much of them, which is new. study found.
Cardiovascular disease, which includes heart disease and stroke, is the number one killer of Americans and is known to take a disproportionate toll on black Americans.
The new study – published October 5 in Journal of the American Medical Association Focuses on risk factors for cardiovascular disease such as high blood pressure, diabetes and obesity. The study authors said that black Americans bear a heavier burden from these conditions than whites, Asians and Hispanics.
But the findings also highlight the main reason behind this.
“A lot of the difference can be explained by social determinants of health,” said lead researcher Dr. Jiang He of the School of Public Health and Tropical Medicine at Tulane University in New Orleans.
The term refers to the broader context of people’s lives and its impact on their health: a healthy diet and exercise might benefit the heart, for example, but it’s easier said than done if you have to work two jobs to pay the rent.
In their study, he and his colleagues were able to calculate some of those social determinants: people’s educational attainment, income, whether they owned a home, and whether they had health insurance and a regular health care provider.
It turns out that these factors went a long way in explaining why black Americans are particularly at risk for heart disease.
The study is not the first to trace the nation’s health disparities to social factors, including structural racism — the ways in which society is created to bestow advantages on one race over another.
Dr. Keith Churchwell was the lead author of a recent statement from the American Heart Association (AHA) on the subject.
In it, the American Heart Association said structural racism needs to be recognized as a “fundamental cause of persistent health disparities in the United States.”
Churchwell said the new findings are in line with previous evidence, of the kind that prompted the American Heart Association’s statement.
Racial disparities in health begin with basic things like educational opportunities, nutrition, stable housing and transportation, according to Churchwell, who is also the president of Yale New Haven Hospital in Connecticut.
“I think we’ve all come to the realization that if we’re going to improve the health of our communities, these social determinants have to be addressed,” said Churchill, who was not involved in the new study. “They have a greater impact than the drugs we give and the procedures we do.”
For the study, He’s team used data from a long-term federal health survey.
Researchers found that between 1999 and 2018, Americans saw an increase in certain risk factors for heart disease and stroke. The prevalence of obesity increased from 30% to 42%, while the prevalence of diabetes increased from 8% to nearly 13%.
Meanwhile, average blood pressure levels remained fairly constant, while blood sugar levels increased.
The picture varied by race and ethnicity, however, black Americans fared worse than white Americans, Asians, and Hispanic Americans.
By 2018, black adults had, on average, an 8% chance of developing heart disease or stroke in the next 10 years (based on their risk factors). The investigators found that compared to about 6% among white Americans.
Then Hu’s team weighed the social factors they could do. These issues seem to explain a great deal of the difference between the cardiovascular risks of black and white Americans.
However, he said the survey did not identify other factors that are more accurate. For example, can people afford healthy food? Do they have safe places to exercise?
Even asking people about “access” to health care fails to tell the full story, he noted: The quality of that care — including whether providers and patients communicate well with one another — is critical.
“If we want to improve the health of the population, we need to pay attention to these social determinants,” he said.
According to Churchill, health care systems can help address broader issues in various ways, including partnering with community organizations and assessing themselves — with the help of electronic medical records — to ensure they provide equitable care.
Churchwell said it is not enough to simply tell patients to eat better and exercise.
On the patient side, encourage people to ask about resources in their community, to help with anything from exercise to mental health support.
“Tell your provider, ‘Help me figure it out,'” Churchill said.
The American Heart Association has more on structural racism and health disparities.
SOURCES: Jiang He, MD, PhD, chair and professor, epidemiology, School of Public Health and Tropical Medicine at Tulane University, New Orleans; Keith Churchill, MD, chief, Yale New Haven Hospital, New Haven, Connecticut; Journal of the American Medical AssociationOctober 5, 2021