Social, Behavioral, and Metabolic Risk Factors and Racial Disparities in Cardiovascular Disease Mortality in U.S. Adults

He, Jiang; Bundy, Joshua D; Geng, Siyi; Tian, Ling; He, Hua; Li, Xingyan; Ferdinand, Keith C.; Anderson, Amanda H.; Dorans, Kirsten; Vasan, Ramachandran S.; Mills, Katherine T.; Chen, Jing

doi:10.7326/m23-0507

Cited by 11 publications

(2 citation statements)

References 32 publications

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“…In a recent study that analyzed National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2018, an improvement in lipid profile was noted in all racial/ethnic groups except the Asian group [46]. In fact, SDOH entirely accounted for the disparity in cardiovascular mortality in another NHANES analysis using data from 1999 to 2018 [47].…”

Section: Discussionmentioning

confidence: 99%

Racial Impact on Inpatient Stroke Quality of Care in Two Community Hospitals

Hussein,

Yang,

Ramezani

et al. 2023

JCM

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Introduction: This analysis was conducted as a part of a quality improvement project aiming at identifying racial disparity in inpatient stroke quality of care. Methods: The Get With The Guidelines (GWTG) database was used to identify all patients discharged with any stroke diagnosis between January and December 2021. An additional chart review was conducted to ensure the accuracy of racial/ethnic categorization. The sample was dichotomized into white vs. non-white groups and compared with univariate analysis. Results: The study sample comprised 1408 encounters (1347 patients) with Mean age of 71 ± 15 years, 51% women, 82% white patients, 15% non-white patients, 72% acute ischemic stroke (AIS); 15% transient ischemic attack (TIA), 9% intracerebral hemorrhage (ICH), 3% subarachnoid hemorrhage (SAH), and 1% stroke not otherwise specified. Non-white patients were younger and had fewer concomitant diagnoses, a lower proportion of TIA, and a higher proportion of ICH (p = 0.004). In the AIS cohort, compared to white patients, non-white patients had less frequent ambulance (p = 0.009), arrived at the hospital later than white patients (7.7 h longer; p < 0.001), had more severe strokes, and had less frequent IV thrombolysis utilization (7% vs. 13%; p = 0.042). Similarly, in the TIA cohort, non-white patients’ utilization of EMS was lower than that of white patients, and their hospital arrival was delayed. In the ICH cohort, non-white patients were younger and had a lower frequency of atrial fibrillation and a non-significant trend toward higher disease severity. The SAH cohort had only eight non-white patients, six of whom were transferred to a higher level of hospital care within a few hours of arrival. Importantly, the hospital-based quality metrics, such as door-to-CT time, door-to-needle time, and the Joint Commission stroke quality metrics, were similar between the two groups. Conclusions: There is a racial disparity in the pre-hospital phase of the stroke chain of survival of non-white patients, impacting IV thrombolysis utilization. The younger age and worse lipid profile and hemoglobin A1c of non-white patients suggest the need for better preventative care starting at a young age.

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Section: Discussionmentioning

confidence: 99%

Racial Impact on Inpatient Stroke Quality of Care in Two Community Hospitals

Hussein,

Yang,

Ramezani

et al. 2023

JCM

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“…15,35 Data from NHANES also supported this, showing that compared to individuals who sleep for a duration of 6-8 hours, those who sleep less than 6 hours have a 19% increased risk of CVD mortality. 36 A study focusing on diabetes patients in the UK Biobank also demonstrates that compared to those who sleep for 7 hours per day, those who sleep less than 5 hours per day have a 26% increased risk of developing ASCVD. 37 As medications for diabetes, such as insulin, can impact sleep duration, 38 we further conducted a sensitivity analysis excluding those who were taking diabetes medications, and the results remain robust.…”

Section: Papermentioning

confidence: 99%

Insulin resistance, combined with health-related lifestyles, psychological traits and adverse cardiometabolic profiles, is associated with cardiovascular diseases: findings from the BHMC study

Yin,

Chen,

Zhu

et al. 2024

Food Funct.

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Choosing to End African American Health Disparities in Patients With Systemic Lupus Erythematosus

Liang,

Lew,

Fraser

et al. 2024

Arthritis & Rheumatology

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Systemic Lupus erythematosus (SLE) is 3 times more common and its’ manifestations more severe in African American (AA) women compared to women of other races. It is not clear whether this is due to genetic differences or factors related to the physical or social environments, differences in health care or a combination of these factors. Health disparities in SLE between AAs and persons of other races have been reported since the 1960's and are correlated with measures of lower socioeconomic status. Risk factors for these disparities have been demonstrated but whether their mitigation improves outcomes for AA patients has not been tested except in self‐efficacy. In 2002, Sacks conducted the first true U.S. population‐based study of SLE with death certificate records and demonstrated a wide disparity between the number of AA women and white women dying from SLE. Five years ago, Yen showed that SLE mortality in the U.S. had improved, but that the AA mortality disparity persisted. Between 2014 and 2021 Lim and others demonstrated racism's deleterious effects in SLE. Racism may have been the unmeasured confounder, the proverbial “elephant in the room” – unnamed and unstudied. The etymology of “risk factor” has evolved from environmental risk factors to social determinants to now include structural injustice/structural racism. Racism in the U.S. has centuries long existence and is deeply ingrained and intertwined making its detection and resolution difficult. However, its being man‐made means mankind can choose to change the situation. Health disparities in SLE should be addressed by viewing healthcare as a basic human right. We offer a conceptual framework and goals for both individual and national actions.

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Social, Behavioral, and Metabolic Risk Factors and Racial Disparities in Cardiovascular Disease Mortality in U.S. Adults

Cited by 11 publications

References 32 publications

Racial Impact on Inpatient Stroke Quality of Care in Two Community Hospitals

Racial Impact on Inpatient Stroke Quality of Care in Two Community Hospitals

Insulin resistance, combined with health-related lifestyles, psychological traits and adverse cardiometabolic profiles, is associated with cardiovascular diseases: findings from the BHMC study

Choosing to End African American Health Disparities in Patients With Systemic Lupus Erythematosus

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