Abstract P108: Race and Socioeconomic Status Are Strongly Associated With Racial Disparities in Cardiovascular Health and Outcomes in Chicago

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Claudia D Ofori-Marfoh ◽  
Caroline Volgman ◽  
Annabelle Volgman ◽  
Sarah Alexander ◽  
Kim Williams
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Health Disparities ◽  
African Americans ◽  
Life Expectancy ◽  
Racial Disparities ◽  
National Level ◽  
Racial Minorities ◽  
Extensive Literature ◽  
Contributing Factors

Introduction: Cardiovascular (CV) disease (CVD) is the leading cause of mortality in Chicago according to the most recent data gathered by the Chicago Department of Public Health (DPH). This is also true at the state and national level. The unique distribution of the population in Chicago along racial/ethnic lines promotes disparity in CVD prevalence and, consequently, higher mortality in certain racial minorities and neighborhoods. We sought to identify the factors contributing to racial disparities in CV health, interventions that have been initiated to address these risk factors and lastly, solutions to decrease this gap in Chicago. Hypothesis: We hypothesize that unique risk factors put certain racial minorities, especially African Americans (AAs), at greater risk for CVD and mortality. Methods: An extensive literature search was performed using PubMed, Scopus and the Chicago DPH Epidemiological database with the search terms/phrases health disparities, CVD, mortality, longevity, life expectancy and Chicago in order to identify contributing factors to racial disparities in CV health and outcomes in Chicago. Results: Many CV risk factors identified at the national level held true for Chicago. Race and socioeconomic status (SES) were repeatedly found to be significantly associated with increased prevalence of CV risk factors with one study finding no association between residence in a primary care health provider-deprived area and increased prevalence of CV risk factors after adjusting for SES and race. AAs, persisting into old age, had poorer control of hypertension (45% vs 51%, p <0.001) relative to their Non-Hispanic White counterparts regardless of their Medicare eligibility status and after adjusting for potential confounders such as SES and obesity. Life expectancy for AA Chicagoans was the lowest at 71.7 with Hispanics having the highest life expectancy at 84.6, and Non-Hispanic Whites at 78.8 years. CVD claims the most lives in Chicago with AAs at greatest risk for CV mortality greatly contributing to longevity being the lowest in this racial subgroup. Interventions identified include city-level efforts such as the Healthy Chicago 2.0 initiative and partnerships involving public, community and healthcare organizations striving to narrow the health disparities gap. Recognition that race and SES are strongly associated with adverse CV health outcomes to a greater extent in certain racial subgroups is a huge step in increasing effective strategies to combat the disproportionate burden of CVD in this subgroup. Conclusion: African Americans in Chicago suffer the greatest burden of CVD and mortality with studies strongly suggesting that race, itself, and SES are leading culprits in this racial disparity.

Abstract P163: Racial Disparities In Coronary Heart Disease Risk Among United States Adults

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Yuan Lu ◽  
Kaveh Hajifathalian ◽  
Majid Ezzati ◽  
Eric Rimm ◽  
Goodarz Danaei
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Health Disparities ◽  
Heart Disease ◽  
High Risk ◽  
Racial Disparities ◽  
Black And White ◽  
Chd Risk ◽  
Risk Distribution ◽  
Age And Sex

Introduction: Health disparities remain pervasive in US and eliminating such disparities is one of the overarching goals of the Healthy People 2020 agenda. Previous studies have assessed the disparities in risk of coronary heart disease (CHD) mortality by race/ethnicity, but most of them only focused on the average CHD risk without taking into account the full risk distribution which would enable analysis of specific high-risk sub-groups. In this study, we estimated the 10-year risk distribution of CHD mortality based on 5 leading modifiable risk factors in US (i.e. smoking, adiposity, high blood pressure, serum cholesterol and blood glucose). We quantified the racial disparities in absolute CHD risk while accounting for full risk distribution. Methods: We included 3866 individuals aged 45 to 74 years, who were black or white, non-pregnant, free of CHD and had measurements of all 5 risk factors from 6 consecutive 2-year cycles of the National Health and Nutrition Examination Survey 1999-2010. We used mortality data from National Center for Health Statistics to estimate the cause-age-sex-race specific mortality in 2010. We also obtained hazard ratios of the selected 5 risk factors on CHD mortality from large meta-analyses of epidemiological studies. We predicted the 10-year risk of CHD death for each individual by simulating their survival process from 2010 to 2020 incorporating competing risks by death from other correlated causes. To assess health disparities, we compared the 5 th , 25 th , 50 th , 75 th and 95 th percentile of the predicted risks between black and white by age and sex. Results: More than half of the black and white population aged 45 to 74 years had a low 10-year risk of CHD death (< 2%). The age-sex-race specific distributions of 10-year CHD risk were right-skewed with a large proportion of population on the low risk tail. Comparing to white, black had similar shape of CHD risk distributions, but higher risk levels at all percentiles across age and sex groups. In 55-64 ages where CHD was the major cause of death, the median of CHD risk for black males was 2.9% (interquartile range (IQR) 1.7% - 4.4%), which was 0.7% larger than that for white males (2.2%, IQR 1.4% - 3.3%). This risk difference was similar in females: the median CHD risk for black females was 1.6% (IQR 0.9% - 2.4%) and 0.9% for white females (IQR 0.5% - 1.5%). The disparities became larger on the high risk tail (95 th percentile of predicted risk), where black had 2.7% higher risk for male and 2.3% for female in 55-64 ages. In older age groups (65-74 ages), such difference increased to 3.5% for both male and female. Conclusions: This analysis showed a skewed 10-year CHD risk distribution in US. The racial disparities are larger in the high risk sub-groups compared to those in the center of the risk distribution, indicating that the high risk subgroups should be the target population of intervention that aims to reduce health disparities in US.

scholarly journals Low Socioeconomic Status Is Associated with Cardiovascular Risk Factors and Outcomes in Systemic Lupus Erythematosus

2012 ◽  
Vol 39 (4) ◽  
pp. 777-783 ◽  
Author(s):  
JANET W. MAYNARD ◽  
HONG FANG ◽  
MICHELLE PETRI
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Socioeconomic Status ◽  
Cardiovascular Risk ◽  
African Americans ◽  
Cardiovascular Risk Factors ◽  
Low Income ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Low Education

Objective.Accelerated atherosclerosis is a major cause of death in systemic lupus erythematosus (SLE), yet little is known about the effect of socioeconomic status. We investigated whether education or income levels are associated with cardiovascular risk factors and outcomes in SLE.Methods.Our study involved a longitudinal cohort of all patients with SLE enrolled in the Hopkins Lupus Cohort from 1987 through September 2011. Socioeconomic status was measured by education level (≥ 12 years or < 12) and income tertiles (> $60,000, $25,000–$60,000, or < $25,000).Results.A total of 1752 patients with SLE were followed prospectively every 3 months. There were 1052 whites and 700 African Americans. Current smoking, obesity, hypertension, and diabetes mellitus were more common in African Americans (p < 0.01 for all), but there was no statistical difference in the frequency of myocardial infarction or stroke. In multivariate analyses stratified by ethnicity, low income was strongly associated with most traditional cardiovascular risk factors in whites, but only with smoking and diabetes in African Americans. In whites, low income increased the risk of both myocardial infarction (OR 3.24, 95% CI 1.41–7.45, p = 0.006) and stroke (OR 2.85, 95% CI 1.56–5.21, p = 0.001); in African Americans, these relationships were not seen. Low education, in contrast, was associated with smoking in both ethnic groups.Conclusion.Low income, not low education, is the socioeconomic status variable associated with cardiovascular risk factors and events. This association is most clearly demonstrable in whites.

scholarly journals Racial Disparities in Adverse Cardiovascular Outcomes After a Myocardial Infarction in Young or Middle‐Aged Patients

2021 ◽  
Author(s):  
Mariana Garcia ◽  
Zakaria Almuwaqqat ◽  
Kasra Moazzami ◽  
An Young ◽  
Bruno B. Lima ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Socioeconomic Status ◽  
Coronary Artery ◽  
Racial Disparities ◽  
Middle Aged ◽  
Aged Patients ◽  
Black Patients ◽  
Artery Disease

Background Black patients tend to develop coronary artery disease at a younger age than other groups. Previous data on racial disparities in outcomes of myocardial infarction (MI) have been inconsistent and limited to older populations. Our objective was to investigate racial differences in the outcome of MI among young and middle‐aged patients and the role played by socioeconomic, psychosocial, and clinical differences. Methods and Results We studied 313 participants (65% non‐Hispanic Black) <61 years old hospitalized for confirmed type 1 MI at Emory‐affiliated hospitals and followed them for 5 years. We used Cox proportional‐hazard models to estimate the association of race with a composite end point of recurrent MI, stroke, heart failure, or cardiovascular death after adjusting for demographic, socioeceonomic status, psychological, and clinical risk factors. The mean age was 50 years, and 50% were women. Compared with non‐Black patients, Black patients had lower socioeconomic status and more clinical and psychosocial risk factors but less angiographic coronary artery disease. The 5‐year incidence of cardiovascular events was higher in Black (35%) compared to non‐Black patients (19%): hazard ratio (HR) 2.1, 95% CI, 1.3 to 3.6. Adjustment for socioeconomic status weakened the association (HR 1.3, 95% CI, 0.8–2.4) more than adjustment for clinical and psychological risk factors. A lower income explained 46% of the race‐related disparity in outcome. Conclusions Among young and middle‐aged adult survivors of an MI, Black patients have a 2‐fold higher risk of adverse outcomes, which is largely driven by upstream socioeconomic factors rather than downstream psychological and clinical risk factors.

scholarly journals Socioeconomic Status, Ecologically Assessed Social Activities, and Daily Cortisol Among Older Urban African Americans

2019 ◽  
Vol 32 (7-8) ◽  
pp. 830-840
Author(s):  
Samuele Zilioli ◽  
Heather Fritz ◽  
Wassim Tarraf ◽  
Susan A. Lawrence ◽  
Malcolm P. Cutchin
Keyword(s):  
Older Adults ◽  
Socioeconomic Status ◽  
African American ◽  
Health Disparities ◽  
African Americans ◽  
Relative Frequency ◽  
Community Dwelling ◽  
Endocrine Function ◽  
Social Activities ◽  
African American Adults

Objectives: Higher socioeconomic status (SES) individuals report more social activities than their lower SES counterparts. Yet, SES and racial health disparities are often confounded. Here, we tested whether the frequency of engagement in social activities contributed to the association between SES and daily cortisol secretion among urban African American older adults. Methods: Ninety-two community-dwelling African Americans aged 55 years and older reported what they were doing at regular intervals across the day on an Android smartphone for seven consecutive days. They also provided four saliva samples at four time points a day during the same period. Results: Higher SES older adults engaged in proportionally more social activities than their lower SES counterparts. A greater relative frequency of weekly social activities was associated with a steeper diurnal cortisol decline. Higher SES was indirectly linked to a steeper cortisol decline via increased relative frequency of weekly social activities. Discussion: Our findings suggest that engagement in weekly social activities represents a behavioral intermediary for SES health disparities in endocrine function among older urban African American adults.

scholarly journals Racial Health Disparities in Coronavirus Deaths

2021 ◽  
Author(s):  
Daniel L. Howard
Keyword(s):  
United States ◽  
African American ◽  
Health Disparities ◽  
African Americans ◽  
Racial Disparities ◽  
Racial Differences ◽  
Causes Of Death ◽  
Current Trend ◽  
Racial Groups ◽  
Racial Health Disparities

Preliminary racial data on the coronavirus pandemic indicates that African Americans are much more likely to experience infections, hospitalizations, and death from the virus in comparison to other racial groups. While this appears to be an alarming health outcome regarding African Americans, it is, in fact, not surprising, nor even new information, considering the historical context of racial health disparities and the marginal health of African Americans in the United States. The leading causes of death for African Americans generally and historically reflects the leading causes of death for the entire United States population. More research, and obviously data, is needed to fully understand the factors that cause the overall racial health disparities, in general, and racial disparities in coronavirus cases and deaths, in particular. In the case of the coronavirus pandemic, the racial disparities in deaths reflect racial differences in the way that African Americans live, work, and exist as a result of their ‘second-class citizenship’ with respect to their lower socioeconomic status in comparison to other racial groups. From a health policy perspective, challenges exist to reversing the current trend in coronavirus deaths among African Americans due to a myriad of historic, consistent, and pervasive societally-induced deficits within African American life. The proposed chapter will rely on systematic review of the extant literature on racial health disparities to identify multiple factors that may affect African American deaths due to the current coronavirus pandemic. The chapter will also rely on this framework to inform evidence-based approaches to improve public health for African Americans.

Abstract P227: Depressive Symptoms and Incident CHD among African Americans and Whites: The Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Mario Sims ◽  
Nicole Redmond ◽  
Yulia Khodneva ◽  
Raegan Durant ◽  
Jewell Halanych ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Depressive Symptoms ◽  
African Americans ◽  
Racial Disparities ◽  
Racial Differences ◽  
Community Dwelling ◽  
Chd Risk ◽  
Regards Study ◽  
Chd Risk Factors

Objectives: African Americans (AA) have higher risk for coronary heart disease (CHD) outcomes than Whites. This racial disparity has been attributed to differences in risk factors such as hypertension, diabetes, smoking, and inactivity. Depression has been associated with CHD risk, both through behavioral factors and possibly through more direct mechanisms. Yet, the role of depressive symptoms in racial disparities in risk of CHD is not clear. Using the REGARDS Study, we examined the association between depressive symptoms and incident CHD. Hypothesis: Depressive symptoms are associated with incident CHD among AA, but not Whites. Methods: REGARDS is a national cohort of US community-dwelling adults aged >45 recruited from 2003 to 2007. Longitudinal associations of depressive symptoms with incident acute CHD (fatal CHD or nonfatal myocardial infarction or coronary revascularization) by race were examined among 24,261 participants (AA = 10,265; Whites =13,996) free of CHD at baseline, and observed through 12/31/09. Baseline depressive symptoms were defined by the 4-item Centers for Epidemiological Studies Depression Scale (CES-D), with continuous scores (0-12 range) dichotomized as normal (<4) or depressive symptoms (≥4). We estimated multivariable Cox proportional hazards models of incident CHD with depressive symptoms, adjusting for sociodemographics, CHD risk factors and health behaviors. Results: Overall mean follow-up was 4.2+1.5 years, CHD incidence was 8.3 events per 1000 person-years (n=366 events) among AA and 8.8 events per 1000 person-years (n=613 events) among Whites, p=0.0015. Depressive symptoms were more prevalent among AA (13.1%) than among Whites (8.5%), p<0.001. There was a significant interaction between race and depressive symptoms, thus models were stratified on race. After adjustment for age, sex, marital status and region, depressive symptoms were significantly associated with incident CHD among AA (HR 1.57 {95% CI 1.18-2.09}) but not among Whites (HR 1.11 {0.80-1.56}). After adding education, income, physical activity, smoking, alcohol consumption, diabetes, BMI, CRP, systolic blood pressure, cholesterol, albuminuria, use of blood pressure or statin medications, the relationship for AA was modestly attenuated but still significant (HR 1.35 {95% CI 1.01-1.81}). Conclusions: Depressive symptoms were associated with risk of incident CHD among AA but not Whites. Efforts to reduce racial disparities in CHD may need to address environmental and psychosocial factors that place AA at higher risk.

Abstract P151: The Association Between Perceived Discrimination And Behavioral Risk Factors Among African Americans In The Jackson Heart Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Mario Sims ◽  
Ana Diez-Roux ◽  
Samsom Gebreab ◽  
DeMarc Hickson ◽  
Marino Bruce ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Socioeconomic Status ◽  
African Americans ◽  
Perceived Discrimination ◽  
Behavioral Risk Factors ◽  
Behavioral Risk ◽  
Men And Women ◽  
Heart Study ◽  
Everyday Discrimination

Objectives. Prior research has reported an association between perceived discrimination and health outcomes among African Americans, and there is growing interest in the pathways in which it gets ‘under the skin.’ One such pathway may be through the association with behavioral risk factors. Using Jackson Heart Study data, we examined whether perceived reports of discrimination were associated with behavioral risk factors among African Americans. Methods. Cross-sectional associations of perceived reports of everyday discrimination, lifetime discrimination, and burden of lifetime discrimination with smoking status, physical activity, percent calories from fat in diet, and hours of sleep were examined among 4,939 participants 20–95 years old (women=3,123; men=1,816). We estimated odds ratios (OR) of current smoking and mean differences in physical activity, fat in diet and hours of sleep with measures of discrimination and adjusted for age and socioeconomic status. Results. Men were more likely to smoke than women, and had higher physical activity scores. Women reported slightly more hours of sleep than men. Men and women reported similar percentages of calories from fat in diet. After adjustment for age and socioeconomic status, perceived everyday discrimination was associated with more smoking and a greater percentage of calories from fat in diet in men and women (OR for smoking: 1.13, 95%CI 1.00–1.28 and 1.19, 95%CI 1.05–1.34; mean difference in percent calories from fat in diet: 0.37, p<.05,0.43, p<.01, in men and women respectively). Everyday discrimination was associated with higher physical activity scores in women (0.11, p<.05) but not men. Everyday and lifetime discrimination were associated with fewer hours of sleep in men and women (everyday discrimination: −0.08, p<.05 and −0.18, p<.001, respectively; and lifetime discrimination: −0.08, p<.05, and −0.24, p<.001, respectively). Lifetime discrimination was associated with more smoking and higher physical activity scores in women only in fully-adjusted models (OR for smoking: 1.17, 95%CI 1.03–1.33; mean difference in physical activity: 0.14, p<.01), and lifetime discrimination was positively associated with percent calories from fat in diet in men only in the fully-adjusted model (0.46, p <.01). Burden of lifetime discrimination was associated with more smoking in women and fewer hours of sleep in women. Conclusions. Behavioral risk factors offer a potential mechanism through which perceived discrimination affects health in African Americans.

scholarly journals Non-Hodgkin Lymphoma Mortality in the Elderly Population By Race, Gender, and Region in the United States

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2535-2535
Author(s):  
Yi Lee ◽  
Qasim Jehangir ◽  
Yu-Che Lee ◽  
Ronan W. Hsieh ◽  
Imran Khan ◽  
...  
Keyword(s):  
New York ◽  
Socioeconomic Status ◽  
Health Disparities ◽  
Survival Rate ◽  
African Americans ◽  
Hodgkin Lymphoma ◽  
State Health ◽  
Non Hodgkin Lymphoma ◽  
The Us ◽  
Males And Females

Abstract Background: Over the past decades, non-Hodgkin lymphoma (NHL) patients have significant improvement in the 5-year relative survival rate. In elderly NHL patients, comorbidities play a major role in mortality. Studies have shown that lower survival rates are multifactorial and strongly associated with certain races, gender, socioeconomic status, and availability of rituximab. Therefore, we aim to assess the differences in causes of mortality among races and genders. To better understand environmental contributions to one-year survival rate in NHL patients state-wise in the US, we examined the mortality-to-incidence rate (MIR) in senior NHL patients characterized by race, gender, and American health ranking (AHR) index. Methods: This is a retrospective study using the Centers for Disease Control and Prevention database from 2008 to 2017. Patients ≥65 years with non-Hodgkin lymphoma were included. AHR assesses the nation's health on a state-by-state basis to determine state health rankings with a composite index of health measures. AHR consists of five weighted core measures (four groups of health determinants and one health outcome): (1). Behaviors including excessive drinking, obesity, smoking, (2). Community and environment including air pollution, poverty, infectious disease, violent crime, (3). Policy including immunization, public health funding, uninsured rate, (4). Clinical care including primary care physicians, mental health providers, preventable hospitalizations, and (5). Outcomes including cancer deaths, cardiovascular deaths, diabetes, disparity in mental status. A ten-year (2008-2017) average of all-determinants value from AHR were reported and MIR, a parameter that can serve as a proxy for survival, was compared between US states. We analyzed the association between NHL mortality and state health disparities using linear regression. Multiple-cause-of-death data is based on death certificates for US residents. Each death certificate contains a single underlying cause of death, up to twenty additional multiple causes, and demographic data. We analyzed the multiple cause age-adjusted mortality rate in White males and females versus African American males and females. All data were analyzed using R version 4.0.5, with p-values &lt;0.05 in two-sided t-tests to indicate statistical significance. Results: In this 10-year analysis, the mean age-adjusted mortality rate (AAMR) in Whites, African Americans, and all populations were 38.2, 21.4, and 36.7 per 1,000,000 population, respectively. Among all 50 states, Idaho had the highest AAMR for all populations (42.7/1,000,000) and Whites (43.1/1,000,000); Minnesota had the highest AAMR for African Americans (29/1,000,000). District of Columbia had the lowest AAMR for all populations (26.4/1,000,000); New Mexico had the lowest AAMR for Whites (30.6/1,000,000) and New York had the lowest AAMR for African Americans (Table 1). Our results demonstrated that elderly NHL patients in states with better health all-determinants index had significantly lower MIR in all populations (R 2=0.2654, p &lt;0.001, Figure 1). The three lowest MIR states in the US were Florida (0.319), Connecticut (0.348), and New York (0.348) (Figure 2). Whites were more likely to have underlying comorbidities than African Americans, especially ischemic heart disease (Male: OR 87.16, 95% CI 74.23-102.34; Female: 26.10, 95% CI 22.01-30.94), congestive heart failure (Male: OR 53.31, 95% CI 45.35-62.66; Female: OR 25.98, 95% CI 22.25-30.34), and chronic obstructive pulmonary disease (Male: OR 54.55, 95% CI 45.27-65.73; Female: OR 45.98, 95% CI 36.48-57.95) (Table 2,3). Conclusions: States of better health index in terms of all determinants had lower MIR for elderly NHL patients in the US. Factors contributing to the difference in MIR possibly include variations in socioeconomic status, insurance coverage, and healthcare access. Our results highlight the need to focus on secondary prevention to decrease morbidities and health disparities in NHL patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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