By Amy Norton
TUESDAY, October 5, 2021 (HealthDay News) – Black Americans have been persistently affected by risk factors for heart disease for the last 20 years – and social issues like unemployment and low income make up a large part of it, a new study finds.
Cardiovascular disease, which includes heart disease and stroke, is the No. 1 killer of Americans and has been known to take a disproportionate toll on black Americans.
The new study, published October 5 in the Journal of the American Medical Association, focused on risk factors for heart and blood vessel diseases such as high blood pressure, diabetes, and obesity. And black Americans carried a heavier burden of these conditions than white, Asian, and Hispanic people, the study authors said.
But the results also show an important reason for this.
“Much of the difference can be explained by social determinants of health,” said lead researcher Dr. Jiang He from the Tulane University School of Public Health and Tropical Medicine in New Orleans.
This term refers to the broader context of people’s lives and the effects it has on their health: eating a healthy diet and exercise, for example, can be good for the heart, but it’s easier said than done when you have to have two jobs to get the rent to pay.
In their study, He and his colleagues were able to explain some of these social determinants: education level, income, home ownership, health insurance, and regular health care.
It found that these factors went a long way towards explaining why black Americans were particularly at high risk for heart disease.
The study isn’t the first to attribute the country’s health disparities to social factors, including structural racism – the way society is positioned to favor one race over another.
Dr. Keith Churchwell was the lead author of a recent American Heart Association (AHA) statement on the matter.
In it, the AHA said that structural racism must be recognized as a “fundamental cause of persistent health inequalities in the United States”.
Churchwell said the new results are consistent with previous evidence that sparked the AHA statement.
According to Churchwell, who is also president of Connecticut’s Yale New Haven Hospital, racial differences in health begin with things as basic as education, nutrition, stable housing, and transportation.
“I think we are all coming to the realization that these social determinants must be addressed if we are to improve the health of our communities,” said Churchwell, who was not involved in the new study. “They have a bigger effect than the drugs we give and the procedures we perform.”
For the study, Hes team used data from a long-term federal health survey.
Investigators found that between 1999 and 2018, Americans saw increases in certain risk factors for heart disease and stroke. The prevalence of obesity rose from 30% to 42%, while the diabetes rate rose from 8% to almost 13%.
Meanwhile, the average blood pressure remained fairly constant while blood sugar levels rose.
The picture varied by race and ethnicity, however, and black Americans were consistently worse off than white, Asian, and Hispanic Americans.
And through 2018, black adults had an average of 8 percent chance of developing heart disease or stroke in the next 10 years (based on their risk factors). That compared to a probability of about 6% in white Americans, the investigators found.
Then He’s team weighed the social factors they could. And these problems seemed to explain a large part of the difference between the cardiovascular risks of black and white Americans.
Still, he said, the survey did not capture any other, more nuanced factors. For example, can people afford healthy food? Do they have safe places to exercise?
Even the question of “access” to health care doesn’t tell the whole story, he noted: the quality of that care – including whether the provider and patient communicate well with each other – is critical.
“If we want to improve the health of the population,” he said, “we have to pay attention to these social determinants.”
Churchwell said health systems can help address wider issues in a number of ways, including partnering with community organizations and self-assessment – using electronic medical records – to ensure they provide equitable care.
It’s not enough simply to tell patients to eat better and exercise, Churchwell said.
On the patient side, he encouraged people to ask about resources in their community for help with everything from exercise to psychological support.
“Say to your utility, ‘Help me find this out,'” said Churchwell.
The American Heart Association has more about structural racism and health disparities.
SOURCES: Jiang He, MD, PhD, Chairman and Professor, Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans; Keith Churchwell, MD, President, Yale New Haven Hospital, New Haven, Connecticut; Journal of the American Medical Association, October 5, 2021