Disparities in heart health persist in the US

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The American Heart Association’s goal of reducing Heart Disease and Stroke by 25 percent by the year 2010 is broadly challenged by racial and socioeconomic disparities in these diseases, according to reports in Circulation: Journal of the American Heart Association.

“Disparities in heart disease and stroke and related risk factors remain very pervasive,” Dr. George A. Mensah said at a news conference today.

Mensah and colleagues, from the Centers for Disease Control and Prevention in Atlanta, analyzed results of national health surveys to provide an overview of the disparities in heart disease and stroke.

"Overall life expectancy was higher in whites than in blacks by five and a half years,” Mensah noted. In fact, “black men and women had higher death rates at all ages compared with whites.”

“Not surprisingly,” he continued, “those with higher education were more likely to have health insurance. Among racial and ethnic groups, Hispanics were least likely to have health insurance and had the highest prevalence of self-reported poor health.”

Rates of obesity were lower in men than women. Overall, the highest rates of obesity were found in black women.

“These data suggest the need for increased emphasis on understanding the determinants of obesity in African-American women and investing in policies and programs to help decrease obesity,” Mensah said.

“Heart disease specialists are aware of the power of prevention and the remarkable advances we’ve made in the treatment and control and overall care of heart disease and stroke,” the researcher said.

However, he added, “I’m always saddened to admit that many ethnic minorities, persons who have low income, those who lack a high school education, women, and millions of Americans without adequate health insurance do not get the quality of health care we are capable of delivering.”

Several other papers in this issue of Circulation highlight the ongoing problems leading to disparities in health care.

For example, Dr. Rachel M. Werner and colleagues at the University of Pennsylvania in Philadelphia report that heart bypass surgery “report cards” lead physicians to avoid treating patients perceived to be at high risk. As a result, a sort of “racial profiling” occurs, such that racial and ethnic minorities are less likely to undergo the procedure.

In the same issue, Dr. Ali F. Sonel, at the VA Pittsburgh Healthcare System, and colleagues followed 5504 black patients and 37,813 white patients with heart attacks and related problems. Blacks were less likely to receive invasive treatment options and newer, more expensive drug treatments.

Even after accounting for insurance status, the disparities persisted, the authors note.

A related report summarizing the AHA’s 2003 Minority Health Summit presents “a blueprint of 10 strategies in research, education, and advocacy” designed to eliminate the observed disparities, conference co-chair Dr. Emelia J. Benjamin told conference attendees.

Benjamin’s group recommends more research into key genetic and environmental factors that underlie different rates of heart disease and stroke among ethnic minorities.

They also call for increased minority participation in scientific studies, both as subjects and as investigators; advocacy to prevent discrimination, increase federal funding of research, and implement primary prevention measures; and removal of barriers that limit access to health care.

SOURCE: Circulation, March 15, 2005.

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