Cardiac risk underestimation in urban, black women

Abstract

Background: Black women have a disproportionately higher incidence of cardiovascular disease mortality than other groups and the reason for this health disparity is incompletely understood. Underestimation of personal cardiac risk may play a role. Objective: We investigated the personal characteristics associated with underestimating cardiovascular disease in black women. Design, Setting, Participants: Trained surveyors interviewed 128 black women during the baseline evaluation for a randomized controlled trial in an urban, academic continuity clinic affiliated with a public hospital system. They provided information on the presence of cardiac risk factors and demographic and psychosocial characteristics. These self‐report data were supplemented with medical record abstraction for weight. Measurements and Main Results: The main outcome measure was the accurate perception of cardiac risk. Objective risk was determined by a simple count of major cardiac risk factors and perceived risk by respondent's answer to a survey question about personal cardiac risk. The burden of cardiac risk factors was high in this population: 77% were obese; 72% had hypertension; 48% had high cholesterol; 49% had a family history of heart disease; 31% had diabetes, and 22% currently used tobacco. Seventy‐nine percent had 3 or more cardiac risk factors. Among those with 3 or more risk factors (“high risk”), 63% did not perceive themselves to be at risk for heart disease. Among all patients, objective and perceived cardiac risk was poorly correlated (κ=0.026). In a multivariable model, increased perceived personal stress and lower income were significant correlates of underestimating cardiac risk. Conclusions: Urban, disadvantaged black women in this study had many cardiac risk factors, yet routinely underestimated their risk of heart disease. We found that the strongest correlates of underestimation were perceived stress and lower personal income.

Outcomes of a Clinic-Based Educational Intervention for Cardiovascular Disease Prevention by Race, Ethnicity, and Urban/Rural Status

“…16 In addition, a lack of awareness of heart disease risk factors translates into an underestimation of risk in both urban and racial minority women. 32 Unlike previous studies assessing differences in knowledge and awareness of heart disease in subgroups of women, 28,33,34 we also developed and assessed a pre-/posteducational intervention. Our intervention differed from others in that it was designed to be delivered in the clinic setting by busy healthcare professionals and within the context of a clinical visit.…”

Trends in self-rated health and association with socioeconomic position in Estonia: data from cross-sectional studies in 1996–2014

“…SRH is based on a single question asking people to rate their overall health status and has been shown to be reliable measure of individuals’ subjective health [6, 7]. According to previous survey results, the prevalence of good SRH varied greatly and was more prevalent among men in countries like Austria, France, Latvia, Norway, Poland, Russia, Armenia as well as in Estonia [8–13] but among women in Finland, Ireland and Great Britain [8].…”

The Impact of Sociodemographic Factors on Knowledge of Cardiac Procedures

“…For example, Woodard and colleagues (2005) found that African Americans demonstrated less knowledge regarding risk factors for cardiovascular disease, compared to Caucasians. The lesser knowledge that African Americans demonstrated regarding risk factors of cardiovascular disease may directly correlate with the finding that African American women with multiple cardiac risk factors underestimated their risk for heart disease [5]. Furthermore, Mosca and colleagues (2000) surveyed over 1,000 women and found that only 8% recognized CHD or stroke as their greatest health concern and less than one-third identified CHD as a leading cause of death.…”