Cardiovascular disease disparities: Racial/ethnic factors and potential solutions
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Corresponding author Keith C. Ferdinand, MD Association of Black Cardiologists, 5355 Hunter Road, Atlanta, GA 30350, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2009, 3:187–193 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2009 by Current Medicine Group LLC
Disparities persist in cardiovascular disease, and it is difficult to separate socioeconomic status from race/ ethnicity or genetic factors. Blacks have more hypertension, with higher cardiovascular morbidity and mortality. Despite high rates of type 2 diabetes and obesity, Hispanics do not appear to have higher cardiovascular mortality than non-Hispanic whites or blacks. South Asians have premature coronary heart disease, with more metabolic syndrome and diabetes. Racial/ ethnic pharmacogenetics does not justify withholding appropriate medications. However, pharmacogenetics demonstrates the importance of using starting doses of medications that are ethnic specific. The Agency for Healthcare Research and Quality reports that the uninsured have difficulty accessing care, which may lead to delayed diagnosis and longer hospitalizations. Minority providers may positively affect the health of an increasingly diverse population.
Introduction Disparities in cardiovascular disease (CVD), the primary cause of mortality, persist in the United States due to race/ ethnicity and socioeconomic status (SES). Racial/ethnic minorities constitute an increasingly large portion of the US population and are the majority in certain regions and urban areas. Minorities now represent about one-third of all Americans and may become the majority by 2042 [1]. In 2010, the estimated US population will reach 308.9 million: 244.9 million white, 40.5 million black, 14.3 million Asian, and 9.3 million others, including about 4.5 million American Indians and Alaska Natives (AI/ANs) and 1 million Native Hawaiians and other Pacific Islanders (NHOPIs) [2]. Life expectancy for black Americans, who
are greatly affected by CVD, is lower than in whites, with a gap of 6 years for men and more than 4 years for women. Life expectancy is 69 years for black men, 76.1 for black women, 75.3 for white men, and 80.5 for white women [3,4]. Although the gaps between whites and blacks have narrowed somewhat since 1950, differences by income and education have grown, confirming a close relationship between SES and mortality. This review identifies several areas of CVD disparities and potentially effective means of improving cardiovascular (CV) care, health outcomes, and clinical practice to eliminate disparities. It is difficult to separate disadvantaged SES from race/ethnicity or to clearly identify genetic factors in considering disparities; certain minorities tend to be poorer, have less advanced education, decreased health insurance status, and less access to primary and specialty care. Furthermore, nuances in responses to medications do not remove the need to apply evidence-based medicine in an equitable fashion.
Race/Ethnicity as Categories for Research and Care The ut
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