Racial Disparities in Cardiovascular Disease–Related Mortality

[Argirios Argiriou]

Journal Watch, August 24, 2023

Racial Disparities in Cardiovascular Disease–Related Mortality
Daniel D. Dressler, MD, MSc, MHM, FACP, reviewing He J et al. Ann Intern Med 2023 Aug 15

In an observational study, social determinants of health accounted for disparities almost completely.

Cardiovascular disease (CVD)–related mortality is about 30% higher in Black patients than in white patients. To determine how various risk factors contribute to that disparity, investigators used a prospective U.S. database to assess mortality outcomes of >50,000 adults (mean age, 47) after adjustment for social determinants of health (i.e., employment, income, food security, homeownership, education, living with a partner, and healthcare and insurance access), behavioral practices (i.e., smoking, diet, physical activity, and sleep), and metabolic risk factors (i.e., obesity, hypertension, diabetes, and hyperlipidemia).

After 10-year mean follow-up, annual CVD-related mortality was significantly higher in Black than white participants (0.48% vs. 0.38%; hazard ratio, 1.54). After separately adjusting for behavioral and metabolic risk factors, CVD-related mortality for Black participants was attenuated — but still significantly higher than for white participants (HRs, ≈1.3). But after adjusting for social determinants of health alone, excess CVD-related mortality for Black participants disappeared (HR, 1.04).

COMMENT
Although metabolic risk factors and individual behaviors are obviously important, social and economic risk factors have substantial impact on disparities in CVD-related mortality. Focusing resources on socioeconomic factors and healthcare access would likely reap valuable gains in healthcare equity.

CITATIONS
He J et al. Social, behavioral, and metabolic risk factors and racial disparities in cardiovascular disease mortality in U.S. adults: An observational study. Ann Intern Med 2023 Aug 15; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος