Disparities In Heart Disease Research Articles

Sex-specific lifetime risk of cardiovascular events: the European Prospective Investigation into Cancer-Norfolk prospective population cohort study.

Better understanding of sex differences in cardiovascular disease (CVD) is essential in tailoring appropriate preventative strategies. Using a large population-based study with follow-up >25 years, we aimed to determine sex-specific lifetime risks of incident CVD and cardiovascular (CV) mortality amongst populations with and without prevalent CVD. Participants were drawn from the European Prospective Investigation into Cancer-Norfolk and followed up for a median of 26.2 years. Sex-specific lifetime risks were ascertained accounting for the competing risk of death. Models were adjusted for ethnicity and time-updated covariates: material deprivation, CV risk factors, lifestyle factors, comorbidities, and medication. A total of 23 859 participants [54.5% women; mean age (standard deviation) 59.2 (9.3) years at baseline] were included. Adjusted lifetime risks of incident CVD were higher in men than in women (69.1 vs. 57.7% at age 75): cause-specific hazard ratio (cHR) (99% confidence interval)-1.49 (1.41-1.57), while the risks of CV mortality at age 75 were 4.4% (men) and 3.1% (women): cHR-1.42 (1.31-1.54). Myocardial infarction was the predominant first presentation in men until the eighth decade. In women, the first CVD manifestations after their sixth decade were predominantly atrial fibrillation and stroke. The male-associated excess relative risks of incident CVD and CV mortality were halved in people with prevalent CVD. We characterized the sex-specific lifetime CV risks in a large cohort. Men had substantially higher risk of incident CVD and CV mortality than women, which was attenuated amongst people with prevalent CVD. Our findings provide an evidence base for sex-specific CV prevention.

Immigrant Legal Status Disparities in Health Among First- and One-point-five-Generation Latinx Immigrants in California

Restrictive US immigration laws and law enforcement undermine immigrant health by generating fear and stress, disrupting families and communities, and eroding social and economic wellbeing. The inequality and stress created by immigration law and law enforcement may also generate disparities in health among immigrants with different legal statuses. However, existing research does not find consistent evidence of immigrant legal status disparities in health, possibly because it does not disaggregate immigrants by generation, defined by age at migration. Immigration and life course theory suggest that the health consequences of non-citizen status may be greater among 1.5-generation immigrants, who grew up in the same society that denies them formal membership, than among the 1st generation, who immigrated as adolescents or adults. In this study, we examine whether there are legal status disparities in health within and between the 1st generation and the 1.5 generation of 23,288 Latinx immigrant adults interviewed in the 2005–2017 waves of the California Health Interview Survey. We find evidence of legal status disparities in heart disease within the 1st generation and for high blood pressure and diabetes within the 1.5 generation. Non-citizens have higher rates of poor self-rated health and distress within both generations. Socioeconomic disadvantage and limited access to care largely account for the worse health of legally disadvantaged 1st- and 1.5-generation Latinx adults in California.

Rural-Urban Disparities in Cardiovascular Disease Mortality Among Middle-Age Men in China.

Rural-urban health disparities are still poorly understood, due to a considerable gap in knowledge, while a looming heart disease and stroke epidemic in China has caused global concern. This report attempts to fill in the knowledge gaps to examine if rural-urban disparities in heart disease and stroke mortality have widened, which population cohorts have experienced the greatest mortality growth and disparities, and if rurality still matters in China. Age-specific data from 2002 to 2016 published in the China Health Yearbooks were analyzed with the Joinpoint Regression Program. The results reveal that China faces a fast growing cardiovascular disease epidemic with widening rural-urban disparities. Rural death rates have grown higher than urban rates along with fast rising rural mortality, and the fastest increasing rates are found among rural men in younger age groups. These findings inspire further research into the causes of the disparities.

Assessing Years of Life Lost Versus Number of Deaths in the United States, 1995-2015.

To assess years of life lost to each cause of death in the United States between 1995 and 2015, and compare it with the number of deaths. We used Vital Statistics mortality data and defined "life-years lost" as remaining life expectancy for each decedent's age, sex, and race. We calculated the share of life-years lost to each cause of death in each year, and examined reasons for changes. In 2015, heart disease caused the most deaths, but cancer caused 23% more life-years lost. Life-years lost to heart disease declined 6% since 1995, whereas life-years lost to cancer increased 16%. The increase for cancer was entirely attributable to population growth and longer life expectancy; had these factors remained constant, life-years lost to heart disease and cancer would have fallen 56% and 38%, respectively. Accidents (including overdoses), suicides, and homicides each caused twice the share of life-years lost as deaths. Measuring life-years lost highlighted racial disparities in heart disease, homicides, and perinatal conditions. Life-years lost may provide additional context for understanding long-term mortality trends.

Integrating and Assessing Structural Competency in an Innovative Prehealth Curriculum at Vanderbilt University.

ProblemStructural competency is a framework for conceptualizing and addressing health-related social justice issues that emphasizes diagnostic recognition of economic and political conditions producing and racializing inequalities in health. Strategies are needed to teach prehealth undergraduate students concepts central to structural competency (e.g., structural inequity, structural racism, structural stigma) and to evaluate their impact.ApproachThe curriculum for Vanderbilt University’s innovative prehealth major in medicine, health, and society (MHS) was reshaped in 2013 to incorporate structural competency concepts and skills into undergraduate courses. The authors developed the Structural Foundations of Health (SFH) evaluation instrument, with closed- and open-ended questions designed to assess undergraduate students’ core structural competency skills. They piloted the SFH instrument in 2015 with MHS seniors.OutcomesOf the 85 students included in the analysis, most selected one or more structural factors as among the three most important in explaining U.S. regional childhood obesity rates (85%) and racial disparities in heart disease (92%). More than half described individual- or family-level structural factors (66%) or broad social and political factors (56%) as influencing geographic disparities in childhood obesity. Nearly two-thirds (66%) described racial disparities in heart disease as consequences of socioeconomic differences, discrimination/stereotypes, or policies with racial implications.Next StepsPreliminary data suggest that the MHS major trained students to identify and analyze relationships between structural factors and health outcomes. Future research will include a comparison of structural competency skills among MHS students and students in the traditional premedical track and assessment of these skills in incoming first-year students.

Decomposing Black-White Disparities in Heart Disease Mortality in the United States, 1973-2010: An Age-Period-Cohort Analysis.

Against the backdrop of late 20th century declines in heart disease mortality in the United States, race-specific rates diverged because of slower declines among blacks compared with whites. To characterize the temporal dynamics of emerging black-white racial disparities in heart disease mortality, we decomposed race-sex-specific trends in an age-period-cohort (APC) analysis of US mortality data for all diseases of the heart among adults aged ≥35 years from 1973 to 2010. The black-white gap was largest among adults aged 35-59 years (rate ratios ranged from 1.2 to 2.7 for men and from 2.3 to 4.0 for women) and widened with successive birth cohorts, particularly for men. APC model estimates suggested strong independent trends across generations ("cohort effects") but only modest period changes. Among men, cohort-specific black-white racial differences emerged in the 1920-1960 birth cohorts. The apparent strength of the cohort trends raises questions about life-course inequalities in the social and health environments experienced by blacks and whites which could have affected their biomedical and behavioral risk factors for heart disease. The APC results suggest that the genesis of racial disparities is neither static nor restricted to a single time scale such as age or period, and they support the importance of equity in life-course exposures for reducing racial disparities in heart disease.

Disparities in cardiovascular disease risk in the United States.

This is a comprehensive narrative review of the literature on the current science and evidence of population-level differences in risk factors for heart disease among different racial and ethnic population in the United States (U.S.). It begins by discussing the importance of population-level risk assessment of heart disease in light of the growth rate of specific minority populations in the U.S. It describes the population-level dynamics for racial and ethnic minorities: a higher overall prevalence of risk factors for coronary artery disease that are unrecognized and therefore not treated, which increases their likelihood of experiencing adverse outcome and, therefore, potentially higher morbidity and mortality. It discusses the rate of Acute Coronary Syndrome (ACS) in minority communities. Minority patients with ACS are at greater risk of myocardial infarction (MI), rehospitalization, and death from ACS. They also are less likely than non-minority patients to receive potentially beneficial treatments such as angiography or percutaneous coronary intervention. This paper looks at the data surrounding the increased rate of heart disease in racial and ethnic minorities, where the risk is related to the prevalence of comorbidities with hypertension or diabetes mellitus, which, in combination with environmental factors, may largely explain CHF disparity. The conclusion is that it is essential that healthcare providers understand these various communities, including nuances in disease presentation, risk factors, and treatment among different racial and ethnic groups. Awareness of these communities’ attributes, as well as differences in incidence, risk factor burdens, prognosis and treatment are necessary to mitigate racial and ethnic disparities in heart disease.

Gary H. Gibbons: a career-defining question.

Gary H. Gibbons, MD, director of the National Heart, Lung, and Blood Institute (NHLBI), has lived a “blessed life.” Molded by a hardscrabble family history, supported by exceptional mentors and educational opportunities, and propelled by an interest in all things science, Gibbons, 58, came of age in an era when new doors were opening to African Americans. In a journey that has taken him to Princeton University, Harvard Medical School, and Brigham & Women’s Hospital—and faculty positions at Stanford University, Harvard, and Morehouse School of Medicine in Atlanta, where he was founding director of the Cardiovascular Research Institute—Gibbons never lost sight of his desire to help people like those he grew up with, working-class African Americans in the inner-city Germantown section of his native Philadelphia. Gibbons, elected to the Institute of Medicine in 2007, has devoted his research career to probing the intricacies of blood pressure regulation, vascular remodeling, and disparities in the cardiovascular health of minorities. As NHLBI director since 2012, Gibbons oversees the third largest institute of the National Institutes of Health (NIH), with a budget of more than $3 billion. Prodded to discuss his career achievements, Gibbons recounts something his mother always told him: Make sure your humility matches your ability. He says he leaves his significance to others to judge. Gary H. Gibbons (Photo courtesy of the National Heart, Lung, and Blood Institute.) I was the youngest of three, and my parents were schoolteachers. I grew up in an era in which I was part of a sort of vanguard cohort—some would call us the Joshua Generation—in which, growing up in inner-city Philadelphia, I was part of the first group of children who was bused as part of desegregation. That happened when I was in third grade, I believe, bused literally across the tracks to a …

Social disparities in heart disease risk and survivor bias among autoworkers: an examination based on survival models and g-estimation

ObjectivesTo examine gender and racial disparities in ischaemic heart disease (IHD) mortality related to metalworking fluid exposures and in the healthy worker survivor effect.MethodsA cohort of white and black men...

Population-based approaches to understanding disparities in cardiovascular disease risk in the United States.

This is a comprehensive narrative review of the literature on the current science and evidence of population-level differences in risk factors for heart disease among different racial and ethnic population in the US. It begins by discussing the importance of population-level risk assessment of heart disease in light of the growth rate of specific minority populations in the US. It describes the population-level dynamics for racial and ethnic minorities: a higher overall prevalence of risk factors for coronary artery disease that are unrecognized and therefore not treated, which increases their likelihood of experiencing adverse outcomes and, therefore, potentially higher morbidity and mortality. It discusses the rate of acute coronary syndrome (ACS) in minority communities. Minority patients with ACS are at greater risk of myocardial infarction, rehospitalization, and death from ACS. They also are less likely than nonminority patients to receive potentially beneficial treatments such as angiography or percutaneous coronary intervention. This paper looks at the data surrounding the increased rate of congestive heart failure in racial and ethnic minorities, where the risk is related to the prevalence of comorbidities with hypertension or diabetes mellitus, which, in combination with environmental factors, may largely explain congestive heart failure disparity. The conclusion is it is essential that health care providers understand these various communities, including nuances in disease presentation, risk factors, and treatment among different racial and ethnic groups. Awareness of these communities’ attributes as well as differences in incidence, risk factor burdens, prognosis, and treatment are necessary to mitigate racial and ethnic disparities in heart disease.

Recent advances in the management of chronic stable angina I: Approach to the patient, diagnosis, pathophysiology, risk stratification, and gender disparities

The potential importance of both prevention and personal responsibility in controlling heart disease, the leading cause of death in the USA and elsewhere, has attracted renewed attention. Coronary artery disease is preventable, using relatively simple and inexpensive lifestyle changes. The inexorable rise in the prevalence of obesity, diabetes, dyslipidemia, and hypertension, often in the risk cluster known as the metabolic syndrome, drives the ever-increasing incidence of heart disease. Population-wide improvements in personal health habits appear to be a fundamental, evidence based public health measure, yet numerous barriers prevent implementation. A common symptom in patients with coronary artery disease, classical angina refers to the typical chest pressure or discomfort that results when myocardial oxygen demand rises and coronary blood flow is reduced by fixed, atherosclerotic, obstructive lesions. Different forms of angina and diagnosis, with a short description of the significance of pain and silent ischemia, are discussed in this review. The well accepted concept of myocardial oxygen imbalance in the genesis of angina is presented with new data about clinical pathology of stable angina and acute coronary syndromes. The roles of stress electrocardiography and stress myocardial perfusion scintigraphic imaging are reviewed, along with the information these tests provide about risk and prognosis. Finally, the current status of gender disparities in heart disease is summarized. Enhanced risk stratification and identification of patients in whom procedures will meaningfully change management is an ongoing quest. Current guidelines emphasize efficient triage of patients with suspected coronary artery disease. Many experts believe the predictive value of current decision protocols for coronary artery disease still needs improvement in order to optimize outcomes, yet avoid unnecessary coronary angiograms and radiation exposure. Coronary angiography remains the gold standard in the diagnosis of coronary artery obstructive disease. Part II of this two part series will address anti-ischemic therapies, new agents, cardiovascular risk reduction, options to treat refractory angina, and revascularization.

Socio-economic disparities in heart disease in the Republic of Lebanon: findings from a population-based study

BackgroundSocio-economic inequalities in the incidence of heart disease exist in developed countries. No data are available on the relation between heart disease and socio-economic status in Arab countries. This study...

Would Achieving Healthy People 2010’s Targets Reduce Both Population Levels and Social Disparities in Heart Disease?

The US Healthy People 2010 (HP2010) agenda set targets for major risk factors for coronary heart disease (CHD). However, the potential impact of achieving those risk factor reductions on both population levels and social disparities in CHD has not been quantified. Data on 10-year risk of CHD (from the First National Health and Nutrition Examination Epidemiological Follow-Up study 1971 to 1982), prevalence of major CHD risk factors (from the National Health and Nutrition Examination Survey 2003 to 2004), and HP2010 targets for CHD risk factors (reduction of smoking rate to 12%, hypertension to 14%, high cholesterol levels to 17%, diabetes to 2.5%, and obesity to 15%) were used to estimate effects of different scenarios on population levels and social disparities in CHD. Over a 10-year period, the largest relative reductions in population levels of CHD (20.0% in men; 23.9% in women) would be achieved if all social groups met the HP2010 targets. CHD disparities would be most reduced if the less educated (absolute disparities reduced by 66.1% in men; 56.3% in women) and the low income group (absolute disparities reduced by 93.7% in men; 94.3% in women) achieved the targets before the most advantaged. These reductions are larger than those expected if targets were achieved overall for the population but relative social group differences in risk factors remained, or under leveling-up approaches in which the least advantaged achieved the current levels of risk factors of the most advantaged. Interventions to reduce CHD risk factors to HP2010 targets that focus on all social groups would produce the best overall scenario for both population levels and disparities in CHD.

Promoting Heart Health in Women

The purpose of this study was to evaluate the effectiveness of a 5-week, 1 hour per week heart disease prevention program for sedentary female municipal workers with known heart disease risk factors. The program was designed to improve participants' knowledge and perceptions of their personal susceptibility to heart disease. In targeting an ethnically diverse, lower income working population, the researchers also sought to contribute to one of the goals of Healthy People 2010, the elimination of health disparities, specifically the reduction of health disparities in heart disease by 25% by the year 2010. A one-group, repeated measures, quasi-experimental design was employed. Forty-eight women 25 to 66 years old responded to the solicitation and participated in the program. Seventy-five percent were African American, 23% were White, and 2% were Latino. Participants completed a 33-item heart disease knowledge questionnaire, demographic questions, and a single visual analog scale statement to assess perceived susceptibility. Fifty-eight percent of the participants improved their knowledge of heart disease and 50% of the participants increased their perception of susceptibility to heart disease from pre- to post-intervention. The greatest improvement in knowledge and awareness of susceptibility occurred for those with limited knowledge and low perceptions of susceptibility. The gains from this workplace health education project for largely minority female municipal workers were modest, but notable. A workplace health education program for women targeted at increasing their knowledge of heart disease may also increase their perceptions of susceptibility to heart disease.

An Evaluation of the Nashville REACH 2010 Community Health Screening Strategy

Community-based screening is 1 of 4 strategies selected by the Nashville REACH 2010 project for reducing disparities in heart disease and diabetes among African Americans in North Nashville, Tenn. We evaluated our screening efforts by asking 4 questions: (1) Are the screening participants representative of the target population? (2) How often were screening participants with possible undiagnosed hypertension, high cholesterol, and diabetes identified? (3) How often were screening participants with an elevated risk for developing hypertension, high cholesterol, and diabetes identified? and (4) How often did we identify screening participants with known hypertension, high cholesterol, and diabetes whose disease management was suboptimal? Results from 1757 persons screened were compared to telephone surveys from 16,199 Nashville residents. Those screened were younger and healthier than the target population. Rates of potentially undiagnosed cases among African Americans were 0.8% for diabetes, 17.4% for hypertension, and 32.7% for high cholesterol. High-risk individuals were identified 13.1% of the time for diabetes, 45.3% of the time for hypertension, and 21.3% of the time for total cholesterol. Rates of poorly controlled known disease were 23.5% for diabetes, 39.0% for hypertension, and 58.2% for total cholesterol. Although we reached a younger and healthier group than the community population, community-based screenings identified many people with potential health risks. We present a model of how to organize and implement successful community-based screening.

Defining Disparities in Cardiovascular Disease for American Indians

Disparities in stroke and heart disease have been well defined in many populations in the United States. Relatively few studies, however, have assessed current disparities in cardiovascular disease in American Indian populations and compared trends with other regions of the United States. Using mortality data, age-adjusted all-cause, heart disease, and stroke mortality rates (per 100,000) were calculated for American Indians and whites from 1991 to 1995 and 1996 to 2000. The all-cause mortality rate was strikingly higher for American Indians than for whites. For example, during 1996 to 2000, the all-cause mortality rate for American Indians (1317, +/-61) was more than half again greater than that for whites (831, +/-8). Heart disease mortality declined significantly in whites (237 to 216 per 100,000) in Montana over the past decade and declined, although not significantly, in American Indians (326 to 283 per 100,000). Stroke mortality also declined significantly in whites (64 to 60 per 100,000) but not in American Indians (80 to 81 per 100,000) during this time period. The proportion of deaths before age 65 years for heart disease and stroke was considerably higher in Indian men (45% and 36%) and Indian women (29% and 28%) compared with white men (21% and 11%) and white women (8% and 7%). The disparity in heart disease and stroke mortality exists between American Indians and whites in Montana. Regional or state-level surveillance data will be needed to describe the changing patterns of heart disease and stroke mortality and cardiovascular risk factors in many native communities in the United States and Canada.

Heart Disease and Prevention

The objective of this study was to analyze race and age differences in the distribution of health promotion and cardiovascular screening tests, and the prevalence of serious heart disease and cardiovascular mortality in the United States. DATA SOURCES/STUDY POPULATION: Data are from 7 federal datasets represented in the first National Healthcare Quality Report and the National Healthcare Disparities Report, and include surveys, administrative and vital statistics data systems. The study analyzes blacks and whites. Counseling on diet and nutrition, exercise, and tobacco during an outpatient visit indicate the availability of health promotion services, and screening for high blood pressure and cholesterol represent preventive services. Hospitalizations for heart-related conditions and use of certain cardiac procedures identify serious heart disease. Deaths from coronary artery disease and stroke are the heart-related mortality measures. Counseling and education services tend to occur more on outpatient visits by individuals aged 45 to 64 years than in younger age groups. Screening rates among individuals aged 45 to 64 years of approximately 90% for hypertension and 80% for high cholesterol suggest progress in early detection of cardiac risk factors. However, blacks aged 45 to 64 years are 5.6 times more likely than their white counterparts to be hospitalized for hypertension, approximately one third less likely to receive a cardiac procedure, and almost twice as likely to die of coronary heart disease. Although findings indicate few racial differences in health promotion services in ambulatory care or screening for cardiac risk factors, the prevalence of serious cardiovascular disease, use of cardiac procedures, and heart-related mortality suggest continuing racial disparities in heart disease.

Race, ethnicity, and geography: disparities in heart disease in women of color.

Cardiovascular disease (CVD) is the leading cause of death in women. Misconceptions about the importance of CVD still persist. These myths affect awareness of CVD and the urgency with which women present for treatment after symptoms develop. Modifiable and nonmodifiable risk factors are more prevalent among ethnic minority women in concentrated geographical locations. The recent publication of the CDC women's atlas presents a unique opportunity for healthcare providers to use derived county-specific data in education, research, and delivery of health promotion and disease prevention services to women of color. Specific recommendations for the nursing profession are provided to assist in eliminating CVD disparities for all women.