Racial Disparities in Cardiovascular Health Among the Acute Coronary Syndrome Population.

Abstract

The relative distribution of proportions of cardiovascular health (CVH) categories within racial groups has been examined. However, little scientific evidence exists on the gap trend in racial/ethnic disparities in mean CVH score among non-Hispanic (NH) Whites and Blacks. This study examined the trend(s) in the gap(s) in predicted CVH scores between NH Whites and Blacks over 10 years. In a cross-sectional analytical study, 10 years of Medical Expenditure Panel Survey data from 2008 to 2018 were pooled, utilizing multivariate Poisson's regression of CVH metrics on race, while controlling for relevant covariates. The interactions of acute coronary syndrome (ACS) with CVH metrics, and other key variables such as trends and grouped Charlson Comorbidity Index allowed for variations in the effect of these variables on the subgroups. The mean gap in CVH scores was on average 0.15 [95% confidence interval (CI) 0.137 to 0.170], with Blacks consistently having reduced odds of having ideal CVH until 2014. The overall impact of having an ACS decreased acquired CVH scores by 24.1% [95% CI -0.275 to 0.207], and was equal for both racial subgroups (P < 0.05). The Affordable Care Act (ACA)-trend was positive, increasing the likelihood of improved CVH in the sample (P < 0.05), deflecting a downward trend in acquired CVH scores for both races, as the gap narrowed into more recent years. The CVH gap was stabilized by the ACA, but never really converged, suggesting that efforts to reduce existing disparities between Blacks and NH Whites in the United States would require government policies to look beyond mere "access" and/or "affordability" to health care.