Death rates from cardiovascular disease are 54% higher among black Americans than among white Americans, a disparity that a recent study attributes to social factors rather than traditional clinical factors. This study highlights the importance of social determinants of health and highlights the need for social and community interventions to address these disparities.
Compared with white people, African Americans have a 54% higher risk of developing cardiovascular disease, even though cardiovascular disease-related deaths have dropped significantly nationwide.
A recent Tulane University study published in the Annals of Internal Medicine found that these racial disparities have more to do with social determinants such as unemployment, limited income, and not having a partner than with previously identified factors such as high blood pressure and obesity.
"For years, we have focused on smoking, diet, physical activity, obesity, high blood pressure, diabetes and high cholesterol -- which we know are important in preventing cardiovascular disease -- but I was surprised to find that the disparity in cardiovascular disease mortality between blacks and whites is driven primarily by social factors," said lead author Dr. Jiang He, the Joseph S. Copps Chair in Epidemiology at Tulane University's School of Public Health and Tropical Medicine.
The study used health data from more than 50,000 adults to examine the relationship between clinical risk factors (obesity, diabetes, high blood pressure and high cholesterol), lifestyle risk factors (smoking, unhealthy diet, lack of exercise, too little or too much sleep) and social risk factors (unemployment, low household income, food insecurity, low education, lack of regular access to health care, no private health insurance, not owning a home, not married or living with a partner) and cardiovascular disease mortality.
When the study adjusted for age and sex, cardiovascular disease mortality among black adults was 54% higher than among white adults. After adjusting for clinical and lifestyle risk factors, this dropped to 34% and 31%, respectively. However, racial differences in cardiovascular disease mortality completely disappeared after adjusting for social risk factors.
"When we adjusted for lifestyle and clinical risk factors, the gap in cardiovascular disease mortality between blacks and whites narrowed but remained," Jiang He said. "However, after adjusting for social risk factors, this racial difference completely disappeared."
The study follows another recent study from Tulane University that also found that black Americans are 59% more likely to die prematurely than white Americans. After adjusting for these social factors, also known as the social determinants of health, the gap shrunk to zero.
While the social determinants of health are a relatively new framework, the CDC's Healthy People 2030 plan highlights it as eight areas of life critical to health and well-being.
For Jiang He, the findings underscore the importance of well-paying jobs, health care services and social support from family or close community.
Going forward, he will put these findings into action with a program to address high blood pressure in New Orleans' black community, partnering with local churches to provide health screening training and free medications.
"It is critical to develop novel community-based interventions to reduce cardiovascular disease risk in Black people," he said.