Racial Disparities In Hypertension Research Articles

Achieving Equity in Hypertension: A Review of Current Efforts by the American Heart Association.

The purpose of this article is to summarize disparities in blood pressure (BP) by race in the United States, discuss evidence-based strategies to increase equity in BP, review recent American Heart Association BP equity initiatives, and highlight missed opportunities for achieving equity in hypertension. Over 122 million American adults have hypertension, with the highest prevalence among Black Americans. Racial disparities in hypertension and BP control in the United States are estimated to be the single largest contributor to the excess risk for cardiovascular disease among Black versus White adults. Worsening disparities in cardiovascular disease and life expectancy during the COVID-19 pandemic warrant an evaluation of the strategies and opportunities to increase equity in BP in the United States. Racial disparities in hypertension are largely driven by systemic inequities that limit access to quality education, economic opportunities, neighborhoods, and health care. To address these root causes, recent studies have evaluated evidence-based strategies, including community health workers, digital health interventions, team-based care, and mobile health care to enhance access to health education, screenings, and BP care in Black communities. In 2021, the American Heart Association made a $100 million pledge and 10 commitments to support health equity. This commitment included implementing multifaceted interventions with a focus on hypertension as a seminal risk factor contributing to disparities in cardiovascular disease mortality and morbidity. The American Heart Association is one organizational example of advocacy for equity in BP. Achieving equity nationwide will require sustained collaboration among individual stakeholders and public, private, and community organizations to address barriers across multiple socioecological levels.

Sex Differences in Sympathetic Transduction in Black and White Adults: Implications for Racial Disparities in Hypertension and Cardiovascular Disease Risk.

The prevalence of hypertension in non-Hispanic black (BL) individuals is the greatest of any racial/ethnic group. While women generally display lower rates of hypertension than men of the same background, BL women display a similar if not greater burden of hypertension compared to BL men. The risk for cardiovascular disease and related events is also highest in BL individuals. Given the importance of the sympathetic nervous system for the regulation of the cardiovascular system, a growing body of literature has investigated sympathetic function in BL and non-Hispanic white (WH) individuals. Herein, we are focused on emerging evidence indicating sympathetic function may be altered in BL individuals, with particular emphasis on the process by which bursts of muscle sympathetic nerve activity (MSNA) are transduced into vasoconstriction and increases in blood pressure (sympathetic vascular transduction). To synthesize this growing body of literature we discuss sex and race differences in 1) sympathetic outflow 2) sympathetic vascular transduction and 3) adrenergic receptor sensitivity. Sex differences are discussed foremost to set the stage for new data indicating a sex dimorphism in sympathetic regulation in BL individuals. Specifically, we highlight evidence for a potential neurogenic phenotype including greater adiposity-independent sympathetic outflow and enhanced sympathetic vascular transduction in BL men that is not observed in BL women. The implications of these findings for the greater hypertension and cardiovascular disease risk in BL adults are discussed along with areas that require further investigation.

The Impact of Social Support, Psychosocial Characteristics, and Contextual Factors on Racial Disparities in Hypertension between Black and White Women

The Impact of Social Support, Psychosocial Characteristics, and Contextual Factors on Racial Disparities in Hypertension between Black and White Women

Association of Circulating Metabolites With Racial Disparities in Hypertension and Stroke in the REGARDS Study.

In the United States, the risk of stroke is greater among Black compared with that among White individuals. However, the reasons for the difference in stroke incidence are not fully elucidated. We aimed to identify metabolites that account for higher prevalent hypertension and incident ischemic stroke among Black adults. We used a stroke case cohort nested within the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Targeted metabolomic profiling of 162 plasma metabolites was performed by liquid chromatography-tandem mass spectrometry. We identified metabolites that were associated with prevalent hypertension and incident ischemic stroke and mediated the relationship between hypertension and ischemic stroke by weighted logistic regression, Cox proportional hazard model, and inverse odds ratio weighting mediation analysis. Incident ischemic stroke cases adjudicated through April 1, 2019 (n = 1,075) were included in the study. The random cohort sample was derived from the full cohort using stratified sampling (n = 968). Among 162 metabolites, gluconic acid was associated with prevalent hypertension in Black adults (odds ratio [OR] 1.86, 95% CI 1.39-2.47, p = 2.58 × 10-5) but not in White adults (OR 1.00, 95% CI 0.80-1.24, p = 0.97; p for interaction = 4.57 × 10-4). Gluconic acid also demonstrated an association with incident ischemic stroke among Black participants (hazard ratio [HR] 1.53, 95% CI 1.28-1.81, p = 1.76 × 10-6) but not White participants (HR 1.16, 95% CI 1.00-1.34, p = 0.057; p for interaction = 0.019). In mediation analysis, gluconic acid mediated 25.4% (95% CI 4.1%-46.8%, p = 0.02) of the association between prevalent hypertension and incident ischemic stroke among Black individuals. Specific socioeconomic factors were linked to elevated gluconic acid level among Black adults in multivariable analysis, including a Southern dietary pattern (β = 0.18, 95% CI 0.08-0.28, p < 0.001), lower educational attainment (β = 0.45, 95% CI 0.19-0.72, p = 0.001), and a lack of exercise (β = 0.26, 95% CI 0.01-0.51, p = 0.045). Gluconic acid is associated with prevalent hypertension and incident ischemic stroke and mediates the relationship between hypertension and ischemic stroke in Black but not White adults. Gluconic acid is a biomarker that is associated with social determinants of health including a Southern diet, low educational attainment, and low physical activity.

Identification of a SGCD × Discrimination Interaction Effect on Systolic Blood Pressure in African American Adults in the Jackson Heart Study.

In the United States, hypertension disproportionately afflicts over half of African American adults, many of whom also experience racial discrimination. Understanding gene × discrimination effects may help explain racial disparities in hypertension. We tested for the main effects and interactive effects of 5 candidate single nucleotide polymorphisms (SNPs: rs2116737, rs11190458, rs2445762, rs2597955, and rs2416545) and experiences of discrimination on blood pressure (BP) in African Americans not taking antihypertensive medications in the Jackson Heart Study from Mississippi (n = 2,933). Multiple linear regression models assumed an additive genetic model and adjusted for ancestry, age, sex, body mass index, education, and relatedness. We additionally tested recessive and dominant genetic models. Discrimination was significantly associated with higher diastolic BP (P = 0.003). In contrast, there were no main effects of any SNP on BP. When analyzing SNPs and discrimination together, SGCD (Sarcoglycan Delta; rs2116737) demonstrated a gene × environment interaction. Specifically, an SGCD × Discrimination interaction was associated with systolic BP (β =1.95, P = 0.00028) in a recessive model. Participants carrying a T allele, regardless of discrimination experiences, and participants with a GG genotype and high experiences of discrimination had higher systolic BP than participants with a GG genotype and low experiences of discrimination. This finding suggests the SGCD GG genotype may have a protective effect on systolic BP, but only in a setting of low discrimination. The inclusion of culturally relevant stressors, like discrimination, may be important to understand the gene-environment interplay likely underlying complex diseases with racial health inequities.

Gut Microbiome and Neuroinflammation in Hypertension.

Hypertension is a worldwide problem with major impacts on health including morbidity and mortality, as well as consumption of health care resources. Nearly 50% of American adults have high blood pressure, and this rate is rising. Even with multiple antihypertensive drugs and aggressive lifestyle modifications, blood pressure is inadequately controlled in about 1 of 5 hypertensive individuals. This review highlights a hypothesis for hypertension that suggests alternative mechanisms for blood pressure elevation and maintenance. A better understanding of these mechanisms could open avenues for more successful treatments. The hypothesis accounts for recent understandings of the involvement of gut physiology, gut microbiota, and neuroinflammation in hypertension. It includes bidirectional communication between gut microbiota and gut epithelium in the gut-brain axis that is involved in regulation of autonomic nervous system activity and blood pressure control. Dysfunction of this gut-brain axis, including dysbiosis of gut microbiota, gut epithelial dysfunction, and deranged input to the brain, contributes to hypertension via inflammatory mediators, metabolites, bacteria in the circulation, afferent information alterations, etc resulting in neuroinflammation and unbalanced autonomic nervous system activity that elevates blood pressure. This in turn negatively affects gut function and its microbiota exacerbating the problem. We focus this review on the gut-brain axis hypothesis for hypertension and possible contribution to racial disparities in hypertension. A novel idea, that immunoglobulin A-coated bacteria originating in the gut with access to the brain could be involved in hypertension, is raised. Finally, minocycline, with its anti-inflammatory and antimicrobial properties, is evaluated as a potential antihypertensive drug acting on this axis.

Racial Disparities in Avoidant Coping and Hypertension Among Midlife Adults.

While associations between stress and hypertension have been documented, little research has examined the association between coping and hypertension, especially in the context of understanding racial disparities. Utilizing data from the CHDS-DISPAR study, we examine the association between avoidant coping and hypertension among adults age 50 while assessing for potential differences across (1) coping in response to the general stress and discrimination and (2) African American and White racial groups. Coping was measured using a 9-item scale with an avoidant coping subscale (e.g., drinking alcohol). Mean avoidance coping scores were calculated for both general stress and discrimination. No racial differences in avoidant coping were found. Within our sample (n = 414), there was a high burden of hypertension among African American respondents compared to White respondents (50.3% vs. 22.6%). Models assessed associations between avoidant coping and hypertension adjusted for sociodemographic factors, obesity, and either experience of stress or discrimination depending on the coping domain examined. Avoidant coping in response to the general stress and discrimination was associated with increased hypertension among White respondents (PR: 1.63 [95%CI 1.01, 2.24]; PR: 1.69 [95%CI 1.12, 2.26], respectively) and no associations among African American respondents (PR: 0.83 [95%CI 0.57, 1.09]; PR: 0.82 [95%CI 0.52, 1.12], respectively). This research suggests that racial disparities in hypertension may not be attributable to individual-level coping behaviors.

Clinical Decision Support to Address Racial Disparities in Hypertension Control in an Integrated Delivery System: Evaluation of a Natural Experiment.

Effective, equity-promoting interventions implemented by health care systems are needed to address health care disparities and population-level health disparities. We evaluated the impact of a clinical decision support tool to improve evidence-based thiazide diuretic prescribing among Black patients to address racial disparities in hypertension control. We employed an interrupted time series design and qualitative interviews to evaluate the implementation of the tool. Our primary outcome measure was the monthly rate of thiazide use among eligible patients before and after implementation of the tool (January 2013-December 2016). We modeled month-to-month changes in thiazide use for Black and White patients, overall, and by sex and medical center racial composition. We conducted key informant interviews to identify modifiable facilitators and barriers to implementation of the tool across medical centers. Of the 318,720 patients, 15.5% were Black. We observed no change in thiazide use or blood pressure control following the implementation of the tool in either racial subgroup. There was a slight but statistically significant reduction (2.32 percentage points, p < 0.01) in thiazide use among Black patients following the removal the tool that was not observed among White patients. Factors affecting the tool's implementation included physician and pharmacist resistance to thiazide use and a lack of ongoing promotion of the tool. The clinical decision support tool was insufficient to change prescribing practices and improve blood pressure control among Black patients. Future interventions should consider physician attitudes about thiazide prescribing and the importance of multilevel approaches to address hypertension disparities.

Abstract 11231: Rethinking the Disconnect in Patient Outreach: Key Considerations in Addressing Racial Disparities in Hypertension

Background: Disparities in hypertension and cardiovascular outcomes among Black men in the US are influenced by social determinants of health (SDOH) and systemic inequity. Self-measured blood pressure (SMBP) monitoring programs may be an efficacious strategy to combat these disparities in the community setting. Leveraging the advantages of SMBP, however, requires improved understanding of barriers to engagement in this population. Methods: A total of 258 Black male patients of a Federally Qualified Health Center, with severe hypertension ( &gt; 160mm Hg systolic or &gt; 100mm Hg diastolic) were eligible. Patients were called using the phone number(s) in the electronic health record (EHR), and callers documented brief summaries of the call. At least 3 attempts were made to offer a free BP cuff, and provide longitudinal SMBP education and heart-healthy lifestyle counseling. NVivo was used for coding and content analysis, employing mixed inductive and deductive approaches to identify barriers to engagement. Coding structure included ‘communication’ and ‘engagement’, stratified by positive and negative attributes. Results: Analysis of initial outreach data (n=172) highlighted themes of unfavorable engagement to include excessive burden from competing health priorities and socioeconomic stress, and communication themes included unreliable phone numbers in the EHR hindering contact, and skepticism/mistrust of the caller by those patients reached. (Table). Conclusion: Optimizing engagement in SMBP programs to address hypertension disparities remains challenging, however improved SDOH screening and resource connection, system practices in EHR integrity, and understanding of patient mistrust of the health system may be key considerations. Ongoing thematic analyses on sustained SMBP skill-building and patient trust in care navigation may provide further insight on strategies to improve racial disparities in cardiovascular health outcomes.

Abstract 12447: Early-Stage, Community-Based Design Process to Understand User Needs for Hypertension Management mHealth Intervention: The WIRED-L Study

Background: Black Americans and older adults have high rates of hypertension and face unique barriers to managing their blood pressure. Using a community-based participatory design approach, we sought out to understand such barriers and determinants for engaging in a healthy lifestyle to inform the development of a wearables-based mHealth intervention. Methods: As part of the Wearables In Reducing risk and Enhancing Daily Life-style (WIRED-L) study, we performed semi-structured discovery interviews of hypertensive adults in Flint and Ann Arbor, MI that relied on the capability, opportunity and motivation behavior (COM-B) framework focusing on 2 behaviors: 1) increase physical activity and 2) decrease salt intake. A rapid analysis approach was used to analyze interview data. Transcripts were used as artifacts for the subsequent empathy mapping session, attended by academic partners and community participants, to contextualize the discovery interviews. Results were compared across study sites. Results: We conducted 9 discovery interviews (Flint = 4 Black people; Ann Arbor = 3 White and 2 Asian people). Physical capability (i.e. pain and disability) and automatic motivation (i.e. habits and drive) were barriers for physical activity, while psychological capability (i.e. understanding), automatic and reflective motivations (i.e. plans and evaluations) were barriers for healthy eating. From empathy mapping that included 12 stakeholders, the primary insight for the Flint user group was a desire to decrease salt intake, but practical constraints exist (e.g., unhealthy foods are the cheaper option, and price is an important factor in health decisions). In the Ann Arbor user group, participants were comfortable with navigating technology and had environments more conducive for physical activity. Conclusion: User groups faced different challenges to maintaining a healthy lifestyle. To reduce hypertension disparities, our design will focus on the barriers that were more prevalent among the Flint population. Our results suggest reducing racial disparities in hypertension will require addressing all phases of mHealth intervention development.

Abstract 17207: Impact of Racial Differences in Treatment Intensification and Missed Visits on Disparities in BP Control

Introduction: Hypertensive black patients have the lowest rates of blood pressure (BP) control. It is unknown to what extent variation in healthcare processes like treatment intensification (TI) and missed visits explain this disparity. Hypothesis: We hypothesized there would be no racial differences in TI but missed visits would be more frequent among black patients and mediate a sizable percentage of BP control disparities. Methods: We used a structural equation multivariate regression model to estimate the likelihood of BP control (BP&lt;140/90 mm Hg) in black vs. white hypertensive patients, mediated by TI and missed visits. We included 6,556 patients who had diagnosis of hypertension and at least one clinic visit with uncontrolled BP (≥140/90 mm Hg) in 12 safety-net clinics in San Francisco from 2015-2017.We used the standard-based method (SBM), which is predictive of BP control, to calculate TI (dose increase or medication addition). We measured missed visits as the number of “no-shows” in the four weeks after an uncontrolled BP. BP control was defined based on the most recent BP as of Nov 15, 2017. The model adjusted for gender, age, first recorded BP between Jan 2015 and Nov 2017, visit frequency, and diagnosis of diabetes. Results: The mean (SD) age was 57.0 (11.2), 41% were female, and 44% were black. Compared to whites, blacks had more missed opportunities for TI (β=-0.02, p&lt;0.001) and missed more visits (β=0.37, p&lt;0.001). After accounting for these differences, black patients remained less likely than whites to achieve BP control (β=0.16, OR=0.85, 95% CI=0.76-0.95). The indirect effect of decreased TI and missed visits accounted for 22% and 13% of the total effect of black race on BP control, respectively (Figure). Conclusion: Racial inequities in treatment intensification may be responsible for over 20 percent of racial disparities in hypertension. Efforts to ensure more equitable treatment intensification may reduce black-white disparities in BP control.

Racial Disparities in Hypertension Prevalence within US Gentrifying Neighborhoods.

Racial disparities in hypertension remain a persistent public health concern in the US. While several studies report Black–White differences in the health impacts of gentrification, little is known concerning the impact of living in a gentrifying neighborhood on hypertension disparities. Data from the American Community Survey were used to identify gentrifying neighborhoods across the US from 2006 to 2017. Health and demographic data were obtained for non-Hispanic Black and White respondents of the 2014 Medical Expenditure Panel Survey (MEPS) residing in gentrifying neighborhoods. Modified Poisson models were used to determine whether there is a difference in the prevalence of hypertension of individuals by their race/ethnicity for those that live in gentrifying neighborhoods across the US. When compared to Whites living within gentrifying neighborhoods, Blacks living within gentrifying neighborhoods had a similar prevalence of hypertension. The non-existence of Black–White hypertension disparities within US gentrifying neighborhoods underscores the impact of neighborhood environment on race differences in hypertension.

Race modifies the association between animal protein metabolite 1-methylhistidine and blood pressure in middle-aged adults: the Bogalusa Heart Study.

Dietary factors mediate racial disparities in hypertension. However, the physiological mechanisms underlying this relationship are incompletely understood. We sought to assess the association between 1-methylhistidine (1-MH), a metabolite marker of animal protein consumption, and blood pressure (BP) in a community-based cohort of black and white middle-aged adults. This analysis consisted of 655 participants of the Bogalusa Heart Study (25% black, 61% women, aged 34-58 years) who were not taking antihypertensive medication. Fasting serum 1-MH was measured using liquid chromatography-tandem mass spectroscopy. Animal food intakes were quantified by food-frequency questionnaires. Multivariable linear regression assessed the association between 1-MH and BP in combined and race-stratified analyses, adjusting for demographic, dietary, and cardiometabolic factors. A significant dose--response relationship was observed for the association of red meat (P-trend <0.01) and poultry (P-trend = 0.03) intake with serum 1-MH among all individuals. Serum 1-MH, per standard deviation increase, had a significant positive association with SBP (β=3.4 ± 1.6 mmHg, P = 0.04) and DBP (β=2.0 ± 1.1 mmHg, P = 0.05) in black participants, whereas no appreciable association was observed in white participants. Among a subgroup of black participants with repeat outcome measures (median follow-up = 3.0 years), one standard deviation increase in 1-MH conferred a 3.1 and 2.2 mmHg higher annual increase in SBP (P = 0.03) and DBP (P = 0.03), respectively. Serum 1-MH associates with higher SBP and DBP in blacks, but not whites. These results suggest a utility for further assessing the role of dietary 1-MH among individuals with hypertension to help minimize racial disparities in cardiovascular health.

Abstract 002: Racial Disparities in Hypertension Among Young, Black and White Women, 1999-2014 National Health and Nutrition Examination Surveys

Black women are at higher risk for cardiovascular disease and its risk factors, including earlier onset compared to their white counterparts. Even with normal blood pressure, Blacks have nearly double the risk of developing hypertension by age 55 years. Despite this increased risk, little attention has been given to racial disparities in hypertension during young adulthood. The objective of this study was to compare prevalence of hypertension among young African American/Black and White women adjusting for other demographic, health behavior, and health status covariates. We used data from the 1999-2014 National Health and Nutrition Examination Survey (NHANES) to perform a cross-sectional analysis of young women aged 18 to 35 years old (n=442; 2,137,064 (weighted)). Compared to White women, Black women in this age group: were less likely to be married; had lower income; were less likely to smoke; and were more likely to report fair or poor self-rated health. In addition, Black women demonstrated higher systolic (116.7(0.88) mm Hg versus 124.3(1.18) mm Hg; p&lt;0.0001) and diastolic (71.7(0.85) mm Hg versus (74.8(1.20) mm Hg; p=0.04) blood pressure on average. In adjusted models, Black women aged 18 to 35 years demonstrated 58% higher likelihood of having hypertension (defined as BP ≥140/90 mm Hg) compared to White women [PR: 1.58 95% CI: 1.29, 1.93]. Adjusting for other factors, race served as the strongest predictor of hypertension among young women aged 18 to 35 years.

Abstract P167: Trends in Hypertension Prevalence, Awareness, and Control Based on the New Definition of Hypertension; A National Health and Nutrition Examination Survey-Based Study

Introduction: Hypertension is a significant risk factor for cardiovascular morbidity and mortality. According to the recent guideline, the criteria for diagnosing hypertension is now 130/80mmhg. This study seeks to gain a better understanding of the prevalence of hypertension, its awareness, and control in the United States population over the last 10 years using the new criteria for hypertension. Methods: NHANES is a stratified multistage probability sampling of the civilian noninstitutionalized population of the United States. We used the last five cycles available (2007-2016) to conduct a prevalence study applying statistical methods to account for the survey technique and non-response. Result: The mean age was 47.33 years (95%CI, 46.82-29.09), females constituted 51.9% of the population(n=28147), non-Hispanic white 66.63%, non-Hispanic black, 11.40%, Mexican American 8.55%. About 39% of the population studied were obese (BMI greater than or equal to 30). The crude ten years prevalence of hypertension was 38.85%, there was an increasing trend from 37.58% in the 2007-2008 cycle to 41.12% in the 2015-2016 cycle; this increase is statistically significant&lt;0.001. In subgroup analysis, 40.12% of non-Hispanic whites were hypertensive compared 48.61% of the black population and 28.65% of Mexican Americans. The age-adjusted prevalence rate of hypertension using the new guideline is 37%, ranging from 12.68% in age 20-39 years to 73.81% in people above 60 years. Non-Hispanic white had an adjusted 10 years prevalence of 35.66%, a minimal trend of 36.02 to 37.14% from 2005-2006 cycle to 2015-2016 cycle while Non-Hispanic black had a trend from 46.88-51.34%,p&lt;0.0001. Awareness of being hypertensive went down from 64.02% in 2005-2006 cycle to 59.90% in the 2015-2016 cycle and control went down from 64.01% to 59.91%. Conclusion: We were able to demonstrate the significant increase in hypertension prevalence with an increasing trend based on the new guidelines. Also, there is a downward trend in awareness and control; we have demonstrated again, the significant racial disparities in hypertension with about half of the black population being hypertensive. Our study showed that there is a need to intensify effort to combat this epidemic.

ADDRESSING RACIAL HEALTH DISPARITIES: LOOKING BACK TO POINT THE WAY FORWARD.

This article investigates the influence of family back-ground and neighborhood conditions during childhood on health later in life, with a focus on hypertension. To document the proportion of current adult racial health disparities rooted in early-life factors, I use nationally representative longitudinal data from the PSID spanning four decades. The results indicate that racial differences in early life neighborhood conditions and family background characteristics play a substantial role in explaining racial disparities in hypertension through at least age 50. Contemporaneous socioeconomic factors account for relatively little of the racial disparities in this health condition in adulthood. Second, I match the Panel Study of Income Dynamics data to county-level data on Medicaid expenditures during these cohorts' childhoods, and provide new causal evidence on the long-run returns to childhood Medicaid spending: Medicaid-induced increases in access to public health insurance led to significant reductions in the likelihood of low birth weight, increased educational attainment and adult income, and reduced adult mortality and the annual incidence of health problems.

ACE gene haplotypes and social networks: Using a biocultural framework to investigate blood pressure variation in African Americans.

Deaths due to hypertension in the US are highest among African Americans, who have a higher prevalence of hypertension and more severe hypertensive symptoms. Research indicates that there are both genetic and sociocultural risk factors for hypertension. Racial disparities in hypertension also likely involve genetic and sociocultural factors, but the factors may interact and manifest differently across racial groups. Here we use a biocultural approach to integrate genetic and social network data to better understand variation in blood pressure. We assay genetic variation at the angiotensin I converting enzyme gene (ACE) and analyze social network composition and structure in African Americans living in Tallahassee, FL (n = 138). We demonstrate that models including both genetic and social network data explain significantly more variation in blood pressure and have better model diagnostics than do models including only one datatype. Specifically, optimal models for systolic and diastolic blood pressure explain a notable 35% and 21%, respectively, of blood pressure variation. Analysis of the social networks reveals that individuals whose networks are dominated by family connections and are more fragmented have higher blood pressure. Historically, family support has been associated with better mental and physical health, but our results suggest that those family connections can also take a toll on health. These findings raise compelling questions regarding the roles of genetics, family, and social environment in hypertension in the African American community and suggest that interactions among these factors may help explain racial disparities in hypertension more accurately than any of the factors alone.

Friends With Health Benefits: The Long-Term Benefits of Early Peer Social Integration for Blood Pressure and Obesity in Midlife

In adults, greater social integration is associated with reduced risk of cardiovascular disease, including hypertension. Social integration earlier in life may be similarly associated with cardiovascular risk. Using a longitudinal sample of 267 Black and White men, we examined whether greater social integration with peers during childhood and adolescence, assessed by parent report, prospectively predicts lower blood pressure and body mass index two decades later in adulthood and whether these effects differ by race, given well-documented racial disparities in hypertension. Boys who were reported by their parents to be more socially integrated with peers evidenced lower blood pressure and body mass index in adulthood, and this effect was not accounted for by body mass index in childhood, childhood socioeconomic status, childhood hostility, childhood physical health, extraversion measured in adolescence, or concurrent adult self-reports of social integration. Results did not differ by race, but analyses were not powered to detect interactions of small effect size.

Promoting Health Equity And Eliminating Disparities Through Performance Measurement And Payment.

Current approaches to health care quality have failed to reduce health care disparities. Despite dramatic increases in the use of quality measurement and associated payment policies, there has been no notable implementation of measurement strategies to reduce health disparities. The National Quality Forum developed a road map to demonstrate how measurement and associated policies can contribute to eliminating disparities and promote health equity. Specifically, the road map presents a four-part strategy whose components are identifying and prioritizing areas to reduce health disparities, implementing evidence-based interventions to reduce disparities, investing in the development and use of health equity performance measures, and incentivizing the reduction of health disparities and achievement of health equity. To demonstrate how the road map can be applied, we present an example of how measurement and value-based payment can be used to reduce racial disparities in hypertension among African Americans.

Disentangling Race and Socioeconomic Status in HealthDisparities Research: an Examination of Black and White Clergy.

Sophisticated adjustments for socioeconomic status (SES) in health disparities research may help illuminate the independent role of race in health differences between Blacks and Whites. In this study of people who share the same occupation (United Methodist Church clergy) and state of residence (North Carolina), we employed naturalistic and statistical matching to estimate the association between race-above and beyond present SES and other potential confounds-and health disparities. We compared the health of 1414 White and 93 Black clergy. Then, we used propensity scores to match Black and White participants on key socioeconomic, demographic, occupational, and physical activity characteristics and re-examined differences in health. Prior to propensity score matching, Black clergy reported worse physical health than their White counterparts. They had greater body mass index, higher prevalence of diabetes and hypertension, and lower physical health functioning. White clergy reported less favorable mental health. They had higher severity of depression and anxiety symptoms as well as lower quality of life and mental health functioning. Propensity score analysis revealed that matching on SES and other key variables accounted for most, but not all, of the observed racial differences. Racial disparities in hypertension, depression severity, and mental health functioning persisted despite adjustments. Race contributed to health disparities in some outcomes in our study population, above and beyond our measures of participants' present SES and key demographic, occupational, and physical activity variables. This study provides evidence supporting the position that race contributes to health disparities through pathways other than SES.