Racial Diversity Among American Cardiologists: Implications for the Past, Present, and Future

In the United States, race-based disparities in cardiovascular disease care have proven to be pervasive, deadly, and expensive. African American/Black, Hispanic/Latinx, and Native/Indigenous American individuals are at an increased risk of cardiovascular disease and are less likely to receive high-quality, evidence-based medical care as compared with their White American counterparts. Although the United States population is diverse, the cardiovascular workforce that provides its much-needed care lacks diversity. The available data show that care provided by physicians from racially diverse backgrounds is associated with better quality, both for minoritized patients and for majority patients. Not only is cardiovascular workforce diversity associated with improvements in health care quality, but racial diversity among academic teams and research scientists is linked with research quality. We outline documented barriers to achieving workforce diversity and suggest evidence-based strategies to overcome these barriers. Key strategies to enhance racial diversity in cardiology include improving recruitment and retention of racially diverse members of the cardiology workforce and focusing on cardiovascular health equity for patients. This review draws attention to academic institutions, but the implications should be considered relevant for nonacademic and community settings as well.

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The Instability of Highly Racially Diverse Residential Neighborhoods in the United States

Sociology of Race and Ethnicity ◽

10.1177/2332649218819168 ◽

2018 ◽

Vol 6 (3) ◽

pp. 365-381 ◽

Cited By ~ 2

Author(s):

Richard Wright ◽

Mark Ellis ◽

Steven R. Holloway ◽

Gemma Catney

Keyword(s):

United States ◽

Predominantly White ◽

Metropolitan Areas ◽

Racial Diversity ◽

Black Population ◽

The United States ◽

Racially Diverse ◽

Absolute Level ◽

The Stability ◽

High Diversity

This research concerns the location and stability of highly racially diverse census tracts in the United States. Like some other scholars, the authors define such tracts conservatively, requiring the significant presence of at least three racialized groups. Of the approximately 65,000 tracts in the country, there were 197 highly diverse tracts in 1990 and 998 in 2010. Most were located in large metropolitan areas. Stably integrated highly diverse tracts were the exception rather than the rule. The vast majority of highly diverse tracts transitioned to that state from being predominantly White. Those that transitioned from being highly racially diverse were most likely to transition to being majority Latino. Although the absolute level of metropolitan racial diversity has no effect on the stability of high-diversity tracts, change in both metropolitan-scale racial diversity and population raise the probability of a tract’s transitioning to high diversity. Metropolitan-scale racial diversity did not affect the stability of highly diverse tracts, but it did alter the patterns of succession from them. The authors also found that highly diverse tracts were unstable and less likely to form in metropolitan areas with high percentages of Blacks. Increased metropolitan-level diversity mutes this Black population share effect by reducing the probability of high-diversity tract succession to a Black majority.

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Food Insecurity Is Associated With Cardiovascular and All‐Cause Mortality Among Adults in the United States

Journal of the American Heart Association ◽

10.1161/jaha.119.014629 ◽

2020 ◽

Vol 9 (19) ◽

Author(s):

Yangbo Sun ◽

Buyun Liu ◽

Shuang Rong ◽

Yang Du ◽

Guifeng Xu ◽

...

Keyword(s):

United States ◽

Cardiovascular Disease ◽

Food Security ◽

Food Insecurity ◽

The United States ◽

Sampling Weights ◽

Cardiovascular Disease Mortality ◽

Disease Mortality ◽

Increased Risk ◽

The Us

Background Food insecurity is a global leading public health challenge that affects not only developing countries but also developed countries, including the United States. About 50 million Americans are food insecure. In this study we examined the associations of the adult food insecurity with all‐cause and cardiovascular disease mortality in a nationally representative sample of US adults. Methods and Results We included 27 188 US adults (age ≥40 years of age) who participated in the US National Health and Nutrition Examination Survey from 1999 to 2014. Food insecurity status was assessed using the Food Security Survey Module developed by the US Department of Agriculture. Mortality from all causes and cardovascular disease was ascertained through data linkage to the National Death Index through December 31, 2015. We used multivariable Cox proportional hazards regression with sampling weights to estimate hazard ratios ( HR s) and 95% CIs of all‐cause and cardiovascular disease mortality, according to food security status. During 205 389 person‐years of the period, 5039 deaths occurred, including 1084 cardiovascular disease deaths. After adjustment for age, sex, race/ethnicity, education, income, and dietary and lifestyle factors, participants with very low food security had higher risk of all‐cause and cardiovascular disease mortality, with multivariable‐adjusted HR s of 1.32 (95% CI , 1.07–1.62), and 1.53 (95% CI, 1.04–2.26), respectively, compared with those with high food security. Conclusions Food insecurity is significantly associated with increased risk of excess death from cardiovascular disease and all causes in US adults.

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Greater Acculturation is Associated With Poorer Cardiovascular Health in the Multi‐Ethnic Study of Atherosclerosis

Journal of the American Heart Association ◽

10.1161/jaha.120.019828 ◽

2021 ◽

Author(s):

Olatokunbo Osibogun ◽

Oluseye Ogunmoroti ◽

Lena Mathews ◽

Victor Okunrintemi ◽

Martin Tibuakuu ◽

...

Keyword(s):

United States ◽

Cardiovascular Disease ◽

Cardiovascular Health ◽

Hispanic Americans ◽

The United States ◽

Foreign Born ◽

Cross Sectional ◽

Lower Odds ◽

Increased Risk ◽

At Home

Background Greater acculturation is associated with increased risk of cardiovascular disease. However, little is known about the association between acculturation and ideal cardiovascular health (CVH) as measured by the American Heart Association's 7 CVH metrics. We investigated the association between acculturation and ideal CVH among a multi‐ethnic cohort of US adults free of clinical cardiovascular disease at baseline. Methods and Results This was a cross‐sectional analysis of 6506 men and women aged 45 to 84 years of 4 races/ethnicities. We examined measures of acculturation(birthplace, language spoken at home, and years lived in the United States [foreign‐born participants]) by CVH score. Scores of 0 to 8 indicate inadequate, 9 to 10 average and 11 to 14 optimal CVH. We used multivariable regression to examine associations between acculturation and CVH, adjusting for age, sex, race/ethnicity, education, income and health insurance. The mean (SD) age was 62 (10) years, 53% were women, 39% non‐Hispanic White‐, 26% non‐Hispanic Black‐, 12% Chinese‐ and 22% Hispanic‐Americans. US‐born participants had lower odds of optimal CVH (odds ratio [OR]: 0.63 [0.50–0.79], P <0.001) compared with foreign‐born participants. Participants who spoke Chinese and other foreign languages at home had greater odds of optimal CVH compared with those who spoke English (1.91 [1.08–3.36], P =0.03; and 1.65 [1.04–2.63], P =0.03, respectively). Foreign‐born participants who lived the longest in the United States had lower odds of optimal CVH (0.62 [0.43–0.91], P =0.02). Conclusions Greater US acculturation was associated with poorer CVH. This finding suggests that the promotion of ideal CVH should be encouraged among immigrant populations since more years lived in the United States was associated with poorer CVH.

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The disease of theories: unravelling the mechanisms of pre-eclampsia

The Biochemist ◽

10.1042/bio03901022 ◽

2017 ◽

Vol 39 (1) ◽

pp. 22-25 ◽

Cited By ~ 1

Author(s):

Eric M. George

Keyword(s):

United States ◽

Cardiovascular Disease ◽

Premature Birth ◽

Molecular Mechanisms ◽

The United States ◽

Life Meaning ◽

Increased Risk ◽

Health Complications ◽

Developed World

Perhaps no disease of pregnancy has been more thoroughly studied than pre-eclampsia (PE), and yet despite all of our efforts we are only beginning to understand the molecular mechanisms which underpin the disease. Many people are surprised by the frequency of PE in the population, as it is believed to occur in approximately one pregnancy out of 20 in the United States, with similar rates throughout the developed world. In severe cases the disorder can progress to eclampsia, which is characterized by maternal seizures and can lead to death. PE can only be treated by ending the pregnancy, often by inducing labour prior to term, making PE a leading cause of premature birth and all of the associated health complications which accompany it. All in all, PE is one of the leading causes of maternal and fetal morbidity and mortality. It is now also becoming apparent that PE disposes both the mother and the baby to increased risk of cardiovascular disease throughout life, meaning that we still don't fully understand the long-term implications of the disease.

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Racial Diversity and Union Organizing in the United States, 1999--2008

10.31235/osf.io/ygbmn ◽

2016 ◽

Author(s):

John-Paul Ferguson

Keyword(s):

United States ◽

Ethnic Diversity ◽

Quantitative Research ◽

Large Scale ◽

Racial Diversity ◽

The United States ◽

The Other ◽

Racially Diverse ◽

Quit Rate

Does racial diversity make it harder to form a union? Case studies giveconflicting answers, and little large-scale research on the questionexists. Most quantitative research on race and unionization studies trendsin membership rather than the outcome of specific organizing drives, andassumes that the main problem is mistrust between workers and unions,paying less attention for example to the role of employers. I explore therole of racial and ethnic diversity in the outcomes of nearly 7,000organizing drives launched between 1999 and 2008. By matching the NationalLabor Relations Board’s information on union activity with the EqualEmployment Opportunity Commission’s surveys of large establishments, Ireconstruct the demographic composition of the work groups involved in eachmobilization. I find that more diverse establishments are less likely tosee successful organizing attempts. However, I find little evidence thatthis is because workers are less interested in voting for unions. Instead,I find that the organizers of more diverse units are more likely to give upbefore such elections are held. Furthermore, this higher quit rate can beexplained best by the other organizations involved in the organizing drive.In particular, employers are more likely to be charged with unfair laborpractices when the unit in question is more racially diverse. This effectpersists when controlling for heterogeneity among industries, unions andregions.

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Abstract MP39: Factors Associated With Adherence To Evidence-based Recommendations For COVID-19 Prevention Among People With Cardiovascular Disease

Circulation ◽

10.1161/circ.143.suppl_1.mp39 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Esther Adeniran ◽

Manik Ahuja ◽

Manul Awasthi ◽

Karilynn Dowling ◽

Mildred Maisonet ◽

...

Keyword(s):

Cardiovascular Disease ◽

Rural Communities ◽

Family Caregivers ◽

Face Mask ◽

The United States ◽

Evidence Based ◽

Adherence Score ◽

Increased Risk ◽

Control And Prevention ◽

Novel Coronavirus

Introduction: The United States Centers for Disease Control and Prevention (CDC) issued behavioral recommendations to limit the spread of the novel coronavirus disease-2019 (COVID-19). No studies have examined the influence of various factors on adherence to COVID-19 preventive measures. Among individuals with co-morbidities, such as cardiovascular disease (CVD) and residing in rural communities, adherence is essential as they are at an increased risk of COVID-19 infection and increased disease severity. Objective: This study aims to explore factors influencing adherence to evidence-based recommendations for preventing COVID-19 among patients/family caregivers with CVD in rural Central Appalachia. Methods: During March-April 2020, 102 CVD Stakeholders - patients/family caregivers, community leaders, and providers from six states across Appalachia participated in a survey administered through REDCap. This study used a subsample (n=73) that excluded providers. Adherence score was defined as the rate of compliance with health authorities’ guidelines, including handwashing, physical distancing, staying home if sick, wearing a face mask, disinfecting and cleaning daily, and cough and sneezing etiquette. Simple and multiple linear regressions were performed to examine associations between adherence scores and variables of interest. Results: Over half (53.42%) of participants complied with all guidelines. Gender, employment status, hypertension, smoking, no insurance, getting information about COVID-19 from Government/CDC website, and getting information about COVID-19 from worship place/club were significantly associated with adherence to CDC recommendations (p<0.05). Compared to low personal perception of threat (PPT), having no and high PPT were associated with lower and higher adherence scores, respectively (β= -2.32, 1.42; p=0.001). Compared to low perception of COVID-19 threat towards family/friends, having moderate or high perception of COVID-19 threat toward family/friends was associated with improved adherence (β= 1.3, 1.57; p<0.05 for both), whereas having no perception was negatively associated with adherence (β= -2.08, p=0.003). Moderate and high perception of COVID-19 threat toward one's community (β= 2.14, 2.06; p<0.001) were likewise associated with higher adherence. R squared for the model= 0.459. Conclusion: Moderate and high perceptions of COVID-19 threats are associated with higher adherence, whereas no perception was associated with lower adherence with health authority recommendations for COVID-19 prevention. These factors should be considered in order to develop effective adherence interventions for CVD stakeholders in rural communities. Results should be confirmed in a larger study.

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Financial Toxicity in Atherosclerotic Cardiovascular Disease in the United States: Current State and Future Directions

Journal of the American Heart Association ◽

10.1161/jaha.120.017793 ◽

2020 ◽

Vol 9 (19) ◽

Cited By ~ 1

Author(s):

Rohan Khera ◽

Javier Valero-Elizondo ◽

Khurram Nasir

Keyword(s):

United States ◽

Cardiovascular Disease ◽

Health Care ◽

Healthcare Providers ◽

Well Being ◽

The United States ◽

Care Quality ◽

Unintended Consequences ◽

Atherosclerotic Cardiovascular Disease ◽

Financial Toxicity

Abstract Atherosclerotic cardiovascular disease (ASCVD) has posed an increasing burden on Americans and the United States healthcare system for decades. In addition, ASCVD has had a substantial economic impact, with national expenditures for ASCVD projected to increase by over 2.5‐fold from 2015 to 2035. This rapid increase in costs associated with health care for ASCVD has consequences for payers, healthcare providers, and patients. The issues to patients are particularly relevant in recent years, with a growing trend of shifting costs of treatment expenses to patients in various forms, such as high deductibles, copays, and coinsurance. Therefore, the issue of “ financial toxicity” of health care is gaining significant attention. The term encapsulates the deleterious impact of healthcare expenditures for patients. This includes the economic burden posed by healthcare costs, but also the unintended consequences it creates in form of barriers to necessary medical care, quality of life as well tradeoffs related to non‐health–related necessities. While the societal impact of rising costs related to ASCVD management have been actively studied and debated in policy circles, there is lack of a comprehensive assessment of the current literature on the financial impact of cost sharing for ASCVD patients and their families. In this review we systematically describe the scope and domains of financial toxicity, the instruments that measure various facets of healthcare‐related financial toxicity, and accentuating factors and consequences on patient health and well‐being. We further identify avenues and potential solutions for clinicians to apply in medical practice to mitigate the burden and consequences of out‐of‐pocket costs for ASCVD patients and their families.

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