Social Determinants Play Outsized Role in Black/White Cardiovascular Health Gap

By Jonathan Springston, Editor, Relias Media

Researchers recently reported Black Americans are 54% more likely than white Americans to die from cardiovascular disease. However, the gap narrowed, then “completely dissipated” after the authors adjusted for clinical and lifestyle factors, then for social determinants of health.

Investigators from Tulane University collected data on more than 50,000 people age 20 years and older from the National Health and Nutrition Examination Survey. Researchers gathered information on clinical risk factors (e.g., obesity, diabetes), lifestyle risk factors (e.g., smoking, unhealthy diet), and social risk factors (e.g., unemployment, no regular access to healthcare). The authors were searching for any association between these and cardiovascular mortality.

Over nearly a decade of follow-up, the authors confirmed more than 2,500 cardiovascular disease deaths occurred (484.7 deaths per 100,000 person-years in Black participants, 384.5 deaths per 100,000 person-years in white participants — a 54% difference). When the authors adjusted for clinical and lifestyle factors, that gap closed to 34% and 31%, respectively. But after adjusting further for social risk factors, the authors noted this gap disappeared.

“For so many years, we have focused on smoking, diet, physical activity, obesity, hypertension, diabetes, and high cholesterol, and we know those are important for the prevention of cardiovascular disease, but it surprised me that the Black-white difference in cardiovascular disease mortality is mainly due to social factors,” said Jiang He, MD, PhD, lead author and Joseph S. Copes Chair in Epidemiology at Tulane’s School of Public Health and Tropical Medicine. “It is essential to develop novel community-based interventions for reducing cardiovascular disease risk in Black populations.”

In 2022, the National Institutes of Health awarded more than $7 million to fund a partnership between Tulane University and several New Orleans-area churches. Researchers will use this money to conduct a five-year study during which church wellness coordinators will be trained to check blood pressure and teach fellow congregants how to check theirs at home. These coordinators also will underscore the importance of preventive medication, exercise, and healthy lifestyle choices.

For more on this and related subjects, be sure to read the latest issues of Clinical Cardiology Alert and Hospital Case Management.