Why are Black Americans more likely to die of heart disease?

Black Americans are 54% more likely to die of heart disease than white Americans. Social factors may explain why, researchers report.

These factors include unemployment, low income, and lack of a partner rather than known factors such as hypertension and obesity.

The racial disparity holds true despite a substantial overall reduction in cardiovascular disease mortality nationwide.

“For so many years we have focused on smoking, diet, physical activity, obesity, hypertension, diabetes, and high cholesterol—and we know those are important for the prevention of cardiovascular disease—but it surprised me that the Black-white difference in cardiovascular disease mortality is mainly due to social factors,” says Jiang He, chair in epidemiology at Tulane University’s School of Public Health and Tropical Medicine and lead author of the study published in the Annals of Internal Medicine.

Using health data from more than 50,000 adults, the study examined the association between clinical risk factors (obesity, diabetes, hypertension, and high cholesterol), lifestyle risk factors (smoking, unhealthy diet, lack of exercise, and too little or too much sleep), and social risk factors (unemployment, low family income, food insecurity, low education, no regular access to health care, no private health insurance, not owning a home, and not being married nor living with a partner) with cardiovascular mortality.

When the study adjusted for age and sex, Black adults had a 54% higher cardiovascular disease mortality rate compared to white adults. That dropped to 34% and 31% after adjusting for clinical and lifestyle risk factors, respectively. But the racial difference in cardiovascular mortality completely dissipated after adjusting for social risk factors.

“When we adjusted for lifestyle and clinical risk factors, the Black-white disparity in cardiovascular disease mortality was diminished but still persisted,” He says. “However, after adjusting for social risk factors, this racial difference totally disappeared.”

This study follows another recent study which similarly found Black Americans are 59% more likely to die prematurely than white Americans. That disparity was reduced to zero after adjusting for these social factors, also called social determinants of health.

Social determinants of health, while a relatively new framework, was emphasized by the CDC’s Healthy People 2030 initiative as eight areas of life critical to health and well-being.

The findings emphasize the importance of well-paying jobs, health care access, and social support that can come from a family or tight-knit community, according to He.

Going forward, He is putting the findings into practice with a program that aims to address hypertension in New Orleans’ Black communities by partnering with local churches to provide health screening training and free medication.

“It is essential to develop novel community-based interventions for reducing cardiovascular disease risk in Black populations,” He says.

Source: Tulane University

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