Cardiovascular Disease in Blacks

Compared to Whites in Massachusetts

Abuchi Agu, Alexander Bogdan,Mellisa Deandrade, Haydy George, Jacqueline Tran

Summer Enrichment Program 2013University of Massachusetts Medical School

What is Cardiovascular Disease?

• Cardiovascular disease is a class of diseases that involve the heart and the blood vessels (arteries, veins, capillaries).

• Examples include:• Coronary Heart Disease• Cardiac dysrhythmia • Heart Failure• Congenital Heart Defects

2

Health Disparity• Defined as inequities in the quality of health care between groups as

compared to the general population. These inequities influence how frequently a disease affects a certain group within the population .

• Black individuals suffer from a signifcantly higher mortality rate from cardiovascular disease when compared to the white population.

3

Source: MassCHIP

Why CVD?

• Cardiovascular disease is the #1 killer in MA of black individuals

• Blacks are 1.5 times more likely to die from CVD than their white counterparts in Worcester County.

• Blacks are more likely to develop multiple risk factors for CVD

4

Source: www.cdc.gov

Symptoms• Chest pain or

discomfort

• Shortness of breath

• Cold sweat

• Abnormal heart beats

• Nausea

• Light-headedness/ dizziness

• Upper body discomfort in one or both arms, the neck, jaw, or stomach.

• Unusual fatigue

5

Source: www.nhlbi.nih.gov

Genesis of Maladies

Despite universal health care, cost still presents a barrier to quality care

• Many minority patients with primary care providers express difficulty communicating with doctors

Source: Kaiser Family Foundation

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Risk Factors 7

Smoking

• Blacks are less likely to quit smoking than whites.

• Smoking prevalence is higher in individuals at or below the poverty line

Source: MassCHIP

8

Physical Inactivity Black individuals are 13.4% less active than the general population

in US; 7.2% less active in Massachusetts

Older black adults and those with low education and income levels are at greatest risk for inactive lifestyles

Source: A Profile of Health Among Massachusetts Adults, 2010

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High Cholesterol Blacks are less often informed of high cholesterol Due to cultural, dietary or genetic differences A 10% decrease in cholesterol can translate to a

25% risk reduction for CVD

Source: MassCHIP

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Hypertension11

• Hypertension increases risk of CVD by nearly 4 times.• Prevalence of hypertension in blacks is highest in the world.• Hypertension leads to about 50% of ischaemic strokes and

significantly increases risk of hemorrhagic stroke.• Blacks are less likely to have controlled blood pressure than

whites.Source: MassCHIP

Obesity Obesity is an

independent risk factor for CVD

Blacks have a higher incidence of obesity than any other race/ethnic group

Proper diet and regular physical exercise can reduce this disparity

12

Source: MassCHIP

Diabetes 13

• Incidence of diabetes in black youths has increased dramatically in past 20 years

• Adults diagnosed with diabetes are up to 4 times more likely to die of CVD

• Smoking with diabetes doubles risk of developing CVD

Source: MassCHIP

DiagnosisAs reported by "Determinants of Black-White Differences in the Risk of Cerebral Infarction: The National Health and Nutrition Examination Survey Epidemiologic Follow-up Study”

• Blacks are less likely to receive major procedures diagnosing CVD, especially coronary heart disease, than the white population.

• Specifically, black women are the least likely to have these procedures recommended.

• In the past, heart disease was thought to be rare in blacks, especially since they had low access to medical care, contributing to present disparity.

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Treatment• Common problems for blacks are cost of medication,

necessity of a multiple-drug regimen, and the inconvenience of frequent follow-up visits.

15

Source: www.city-data.com, Overview of the Uninsured in the United States: A Summary of the 2011 Current Population Survey

Current Efforts to Reduce CVD Disparity

• HAPPY Hearts Program Focus on low-income women Offers screenings and aggressive primary

prevention techniques Effectively reduces incidence of metabolic

syndrome, a strong predictor of CVD

• Additional studies conducted to reduce disparity:• Control of psychosocial stress

• Community education programs

• Programs educating physicians to treat diverse populations

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Summary of Findings

• There are many prevalent risk factors contributing to CVD

• Disparities exist between black and white populations in all risk factors for CVD

• Disparities also exist in socioeconomic status and accessibility to health care

• Diagnostic inefficiency may be key to disparity prevalence

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Conclusion

• Research suggests disparities in risk factors reinforce CVD disparity between blacks and whites

• Economic inequality and accessibility of care further stigmatize CVD disparity

• Investigation is needed into existence of diagnostic disparities and their resolution

• Establishment of community-based primary prevention programs have been proven to reduce disparity

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