Race, Racism, and Cardiovascular Health: Applying a Social Determinants of Health Framework to Racial/Ethnic Disparities in Cardiovascular Disease

Abstract

Health care in the United States has seen many great innovations and successes in the past decades. However, to this day, the color of a person’s skin determines—to a considerable degree—his/her prospects of wellness; risk of disease, and death; and the quality of care received. Disparities in cardiovascular disease (CVD)—the leading cause of morbidity and mortality globally—are one of the starkest reminders of social injustices, and racial inequities, which continue to plague our society. People of color—including Black, Hispanic, American Indian, Asian, and others—experience varying degrees of social disadvantage that puts these groups at increased risk of CVD and poor disease outcomes, including mortality. Racial/ethnic disparities in CVD, while documented extensively, have not been examined from a broad, upstream, social determinants of health lens. In this review, we apply a comprehensive social determinants of health framework to better understand how structural racism increases individual and cumulative social determinants of health burden for historically underserved racial and ethnic groups, and increases their risk of CVD. We analyze the link between race, racism, and CVD, including major pathways and structural barriers to cardiovascular health, using 5 distinct social determinants of health domains: economic stability ; neighborhood and physical environment ; education ; community and social context ; and healthcare system . We conclude with a set of research and policy recommendations to inform future work in the field, and move a step closer to health equity.

Use of clinical pharmacy services by American Indians and Alaska Native adults with cardiovascular disease

“…Fourth, we found 3 of 4 SDOH, referenced in the Healthy People SDOH framework, 11,41 were associated with lower utilization. Adults with Medicaid coverage, which generally indicates low household income, were 72% less likely to use services than adults without Medicaid coverage.…”

“…1 This difference was largely attributable to disparities in mortality associated with heart disease, stroke, diabetes, and kidney disease. 1 Structural racism combined with continued disparities in determinants of health [8][9][10][11] and existing AI/AN cardiovascular disease (CVD) risk factors 12 contribute to higher rates of premature death due to heart disease, stroke, and diabetes among AI/ANs. [2][3][4] Innovative service delivery models are needed to address CVD risk factors among AI/ANs, particularly in rural areas with low household incomes.…”

Carotid atherosclerosis in people of European, South Asian and African Caribbean ethnicity in the Southall and Brent Revisited study (SABRE)

“…Our failure to identify factors explaining ethnic differences in carotid atherosclerotic plaque despite extensive adjustment for conventional and novel risk factors suggests that important determinants of atherosclerosis remain to be identified. Mechanisms related to population migration,(31) socio-economic disadvantage(32) and racism (32,33) seem plausible explanations, but given the differences observed between minority ethnic groups in this study this question merits further study. We cannot exclude genetic differences between populations of difference ancestry but currently there is little or no evidence to suggest that genetics makes an important contribution to ethnic differences in susceptibility to CVD.…”

A National Strategy for COVID Response and Pandemic Preparedness Must Address Noncommunicable Chronic Diseases

“…Partnerships between medical systems and community-based organizations and efforts by public and private insurers for the COVID emergency response could be built on to facilitate integration of behavior change interventions into routine healthcare delivery and coverage. Partnering with community-based organizations and policy makers would be essential for prioritizing under-resourced populations and communities of color and dismantling structural racism and related upstream determinants as root causes of inequities 7 in NCDs in general and in severe and fatal COVID-19 outcomes.…”

“…Policies to improve environmental and socioeconomic conditions, increased investment, and sustained efforts to overcome racism, classism, and poverty are required to improve population health and health equity. 7 …”