DALLAS, March 3, 2021 – The association between race and ethnicity and specific characteristics of some North American counties may have a significant impact on mortality rates from cardiovascular diseases, according to new research published today in Journal of the American Heart Association, an open access newspaper from the American Heart Association.
Cardiovascular disease is the leading cause of death in the United States across all racial and ethnic groups, and disparities in cardiovascular outcomes for minority racial and ethnic groups have been widely documented. This study presents a detailed analysis of the county level predictors of cardiovascular mortality rates among the white, Hispanic / Latin and black populations.
Using 2017 data from the Centers for Disease Control and Prevention Comprehensive Online Data for Epidemiological Research (CDC WONDER) and the 2017 Robert Wood Johnson County Health Rankings, researchers assessed variations in cardiovascular disease mortality rates between racial and ethnic groups and the degree to which factors in the county were responsible for the differences in mortality rates.
Municipal level factors, some known as social determinants of health, analyzed:
- demographic factors: population size, rural percentage, percentage of women, percentage of black residents, percentage of Asian residents and percentage of Hispanic / Latino residents;
- census region: Northeast, Midwest, South or West;
- socioeconomic factors: percentage of residents who completed some college, who are unemployed, with food insecurity (limited access to fresh, healthy and cheap food) and average family income;
- traditional cardiovascular risk factors: percentage of residents who were smokers, were physically inactive, who had type 2 diabetes and percentage of obesity; and
- factors of access to health care: proportion of primary care providers per 100,000 inhabitants and percentage of uninsured adults.
The researchers used regression models to determine the association between each of the factors at the county level and the age-adjusted cardiovascular mortality rates for each race / ethnicity. They also assessed the factor responsible for the greatest variation in mortality rates.
Among the study’s main findings:
- Black adults had the highest average mortality rate from cardiovascular disease, 320 deaths per 100,000 person-years, compared to Hispanic / Latino adults, with the lowest rate of 168 deaths per 100,000 person-years.
- The highest death rates from cardiovascular disease in all racial and ethnic groups occurred in the southern states (Alabama, Arkansas, District of Columbia, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, Carolina South, Texas, Tennessee, Virginia and West Virginia).
- The risk factors for traditional cardiovascular diseases were responsible for the greatest variation in the mortality rates due to cardiovascular diseases among whites (35%), while socioeconomic concerns explained a large part of the variation in the mortality rate among blacks (26%) and the demographic data explained the variation between Hispanics / Latinx populations (35%).
- Socioeconomic factors ranked second among whites and Hispanics / Latinos (32% and 27%, respectively) in explaining the greater variation in deaths from cardiovascular disease.
These results can help develop and implement effective interventions to improve cardiovascular outcomes, said study co-author Justin Parizo, MD, a transplant cardiologist and advanced heart failure at Stanford University in Stanford, California.
“Currently, health interventions in the population and the community are typically focused on medical and disease risk factors, however, our analysis suggests that more emphasis should be placed on intervention that can improve social determinants of health, particularly for black people, “Parizo said. “As examples, several studies have shown that income supplementation, in addition to nutritional counseling, can improve the diet among populations at risk for cardiovascular disease. In addition, interventions to improve housing have been shown to increase patient exercise levels and, in the long run, may decrease health-damaging results, such as obesity and type 2 diabetes.
As the research is observational and retrospective, the results cannot prove cause and effect. Another limitation of the study is the interpretation of risk factors at the municipality level, which does not necessarily describe subpopulations within each municipality. “For example, a 40% obesity rate among blacks in a county represents the entire black population, but it does not necessarily apply to all subgroups of the black population,” said Parizo.
“The greatest value of this study is that it informs the understanding of the health of the cardiovascular population and the numerous factors that play a role in cardiovascular health,” said senior study co-author Fátima Rodriguez, MD, MPH, assistant professor of cardiovascular medicine and preventive cardiologist and researcher of health disparities at the Stanford Prevention Center at Stanford University School of Medicine. “Not all populations are the same. A differentiated understanding of the unique influences on cardiovascular outcomes is essential to reduce disparities between various population groups.”
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Other co-authors are Bongeka Z. Zuma, M.Sc .; Areli Valencia, BA; Gabriela Spencer-Bonilla, MD, M.Sc .; Manuel R. Blum, MD, M.Sc .; and David Scheinker, Ph.D.
The study was funded by the Stanford Medical Scholars Fellowship Program; the National Institute of Heart, Lung and Blood of the National Institutes of Health; and the American Heart Association / Robert Wood Johnson Harold Amos Faculty Development Program.
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After March 3, see the manuscript online.
Food insecurity associated with increased risk of cardiovascular death
Housing conditions affect cardiovascular health risks
Health disparities in rural USA: higher mortality from coronary artery disease in women under 65 and people with heart failure
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