Abstract 15576: The Association of Structural Racism With Cardiovascular Disease Death Rates

Abstract

Background Structural racism is an upstream influencer of social determinants of health, which impact cardiovascular disease (CVD) death rates. The association between structural racism and CVD death rates has not been conclusively quantified, and this association may vary by race/ethnicity. Method Year 2020 census data on disparities in income, wealth, education, employment, and digital access and segregation were available at the census block group level and were used to quantify structural racism’s effects. Data from each block group and its 9 nearest neighbors were used to compute the structural racism sub-scores for that block group, which were transformed to a scale of 1-100 based on 100 quantiles. The composite score was then calculated as the weighted sum of the sub-scores (weights in Table 1). Mean structural racism score (SRS), weighted by population of each block group, was computed for each county in the United States. Then SRS was fit as the exposure in linear models controlling for state and predicting 2020 county-level CVD death rates per 100,000 adults for all residents, non-Hispanic Black (NHB) residents, non-Hispanic White (NHW) residents, and Hispanic residents, as reported by the Centers for Disease Control. Results: Data from 50 states and the District of Columbia were used (3137 counties). A 1-point higher SRS score (range 1-100) was associated with 1.0 (95% CI: 0.8, 1.3) more CVD deaths per 100,000 adults. Among NHB residents, there were 1.5 (95% CI: 1.0, 2.0) more CVD deaths per 1-point higher SRS score. Among Hispanic and NHW residents, CVD deaths were 0.8 (95% CI: 0.4, 1.2) and 0.6 (95% CI: 0.3, 0.8) higher per 1-point higher SRS. Conclusion: Structural racism is associated with greater CVD mortality among all United States residents, but the magnitude of association is greatest among NHB residents. Eliminating structural racism is likely to reduce CVD mortality of all residents while reducing race-based disparities in CVD mortality.