Race and Medicine

Race and Medicine

Disclosures: The authors report no relevant financial disclosures.
October 05, 2021
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CVD, risk factor prevalence greater in Black vs. white Americans

Disclosures: The authors report no relevant financial disclosures.
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Over 20 years, CVD risk and CV risk factor prevalence was greater in Black Americans compared with white Americans, though the difference may have been mediated by social determinants of health, researchers reported.

Jiang He, MD, PhD, Joseph S. Copes Chair of Epidemiology in the School of Public Health & Tropical Medicine at Tulane University and professor and director of the Tulane University Translational Science Institute, and colleagues analyzed 50,571 participants (mean age, 49 to 52 years; 48% to 51% women) from the National Health and Nutrition Examination Survey cross-sectional surveys from 1999 to 2018.

Graphical depiction of data presented in article
Data were derived from He J, et al. JAMA. 2021;doi:10.1001.jama.2021.15187.

Eliminating disparities

Jiang He

“Understanding the secular trends of cardiovascular risk factors among U.S. subpopulations with various racial and ethnic backgrounds and socioeconomic status may be helpful to guide the development of national public health policies for targeted interventions aimed at eliminating health disparities,” the researchers wrote in JAMA.

During the study period, age- and sex-adjusted BMI rose from 28 kg/m2 to 29.8 kg/m2, HbA1c increased from 5.4% to 5.7%, serum total cholesterol dropped from 203.3 mg/dL to 188.5 mg/dL and smoking prevalence fell from 24.8% to 18.1% (P for trend for all < .001), He and colleagues wrote.

Systolic BP declined from 123.5 mm Hg in 1999-2000 to 120.5 mm Hg in 2009-2010, but then rose to 122.8 mm Hg in 2017-2018 (P for nonlinear trend < .001), the researchers wrote.

Mean age- and sex-adjusted 10-year atherosclerotic CVD risk fell from 7.6% in 1999-2000 to 6.5% in 2011-2012, but was flat after that, according to the researchers.

Compared with non-Hispanic white participants, non-Hispanic Black participants had higher age- and sex-adjusted BMI, systolic BP and HbA1c and lower total cholesterol throughout the study period (P < .001 for all between-group differences), He and colleagues wrote.

Regardless of race or ethnicity, those with at least a college education and those with a high family income had lower levels of CVD risk factors than those with lower levels of education and income, according to the researchers.

ASCVD risk

The mean 10-year ASCVD risk adjusted for age and sex was higher in non-Hispanic Black participants than in non-Hispanic white participants both in the first half of the study period (difference, 1.4%; 95% CI, 1-1.7) and in the second half (difference, 2%; 95% CI, 1.7-2.4), but the differences were attenuated after adjustment for education, income, home ownership, employment, health insurance and access to health care (difference in first half, –0.3%; 95% CI, –0.6 to 0.1; difference in second half, 0.7%; 95% CI, 0.3-1), He and colleagues wrote.

“Although cardiovascular disease mortality and risk factors have decreased significantly since 1950, Black persons still have higher risk compared with individuals in other racial and ethnic groups,” the researchers wrote. “To our knowledge, this is the first study to report that body mass index, systolic blood pressure and hemoglobin A1c were persistently higher in the Black population compared with the White population after adjustment for important social determinants of health, such as education, income, housing, employment, health insurance and access to health care. Other unmeasured social determinants, such as neighborhood and physical environment, access to healthy foods and social integration, were not included in this analysis but seem likely to play an important role in racial and ethnic differences.”