Why are black adults at higher risk of death from heart disease?

2023-08-14 23:59:38

Black Americans are 54% more likely to die from cardiovascular disease than white Americans, despite the fact that there has been a substantial overall reduction in mortality from this cause across the country.

Now, a new study from Tulane University published in the Annals of Internal Medicine has found that this racial disparity can be attributed to social factors such as unemployment, low income and lack of a partner rather than known factors such as high blood pressure and the obesity.

“For so many years we have focused on smoking, diet, physical activity, obesity, hypertension, diabetes, and high cholesterol, and we know they are important for cardiovascular disease prevention, but I was surprised that the difference between blacks and whites in cardiovascular disease mortality is mainly due to social factors“explains Dr. Jiang He, Professor of Epidemiology at the Tulane School of Public Health and Tropical Medicine and lead author of the study.

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 healthcare, no private health insurance, not having their own home, not being married or living with a partner ) with cardiovascular mortality.

When the study adjusted for age and sex, black adults had a 54% higher rate of death from cardiovascular disease compared with 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 the social risk factors.

“When we adjusted for lifestyle and clinical risk factors, the black-white disparity in CVD mortality narrowed but still persisted,” He notes. “However, after adjusting for social risk factors, this racial difference completely disappeared,” he says.

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

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

The lead author is putting these findings into practice with a program that aims to address high blood pressure in black communities in New Orleans by partnering with local churches to provide training on free health screenings and medications.

“It is essential to develop new community-based interventions to reduce the risk of cardiovascular disease in black populations,” he says.