Disparities in Cardiovascular Medicine
2021; Lippincott Williams & Wilkins; Volume: 143; Issue: 24 Linguagem: Italiano
10.1161/circulationaha.121.055565
ISSN1524-4539
AutoresMichelle A. Albert, Mercedes R. Carnethon, Karol E. Watson,
Tópico(s)Cardiac Health and Mental Health
ResumoHomeCirculationVol. 143, No. 24Disparities in Cardiovascular Medicine Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessResearch ArticlePDF/EPUBDisparities in Cardiovascular Medicine Michelle A. Albert, MD, MPH, Mercedes R. Carnethon, PhD and Karol E. Watson, MD, PhD Michelle A. AlbertMichelle A. Albert Department of Medicine (Cardiology), University of California, San Francisco (M.A.A.). , Mercedes R. CarnethonMercedes R. Carnethon https://orcid.org/0000-0001-7035-0848 Department of Preventive Medicine and Medicine (Pulmonary and Critical Care), Northwestern University, Chicago, IL (M.R.C.). and Karol E. WatsonKarol E. Watson Correspondence to: Karol E. Watson, MD, PhD, Division of Cardiology, David Geffen School of Medicine at UCLA Health Sciences, 650 Charles E. Young Dr, South A2-237 CHS MC #167917, Los Angeles, CA 90095-7103. Email E-mail Address: [email protected] https://orcid.org/0000-0003-3658-6165 Department of Medicine (Cardiology), University of California, Los Angeles (K.E.W.). Originally published14 Jun 2021https://doi.org/10.1161/CIRCULATIONAHA.121.055565Circulation. 2021;143:2319–2320At Circulation, we are highly committed to diversity, equity, and inclusion spanning race, ethnicity, sex, gender, age, geography, and more. To this end, we have commissioned our first annual themed issue focusing on disparities. Our commitment to publishing this issue follows an unprecedented year when disparities were at the forefront of our consciousness because of the coronavirus disease 2019 (COVID-19) pandemic and social unrest. Race remains an important issue in our society, and in this inaugural issue we will focus exclusively on the experiences of people of African descent; in subsequent issues we will expand to address disparities in other populations. The focus on cardiovascular health in persons of African descent is justified based on the persistent disparities in morbidity and mortality from cardiovascular diseases that are experienced by Black adults and children in the United States.1 Also, as we have seen, pandemics, and preventable deaths, as well, disproportionately affect Black individuals with disparities in COVID-19 deaths and cardiovascular diseases being classic examples, highlighted in the articles by Rodriguez et al2 and Wadhera et al.3It is important to remember that health disparities are not merely differences in health status, but, as the World Health Organization states, health disparities are "systematic, socially produced (and therefore modifiable) and unfair."4 Disparities research frequently focuses on race and ethnicity without emphasizing that race and ethnicity are social constructs defined by shared common cultural or social traditions.5 Whereas racial or ethnic groups may share physical traits, these observable traits do not reflect differences in genetics or biology. However, there may be biological or genetic manifestations that segregate along racial and ethnic lines because of shared social and cultural experiences. The article by Joseph et al6 identifies biological variables associated with blood pressure levels. Whereas pharmacotherapies are developed to be equally effective in all individuals, there is the potential for a greater population health benefit if a medication is used in a population subgroup with a higher underlying rate of disease. That possibility is reviewed by Morris et al.7 Last, thoughtful incorporation of race into risk assessment provides an opportunity to identify at-risk populations sooner so that interventions to prevent disease can be deployed. However, it must be acknowledged that incorporation of race likely serves as an inexact proxy that captures social adversity. Segar et al present original research on this topic in heart failure.8Health disparities exact a heavy toll on individuals from the hardest-hit populations while simultaneously stressing the entire health care system and economic infrastructure of society. Given that cardiovascular diseases develop earlier in life in Black individuals and other disadvantaged populations, the health care system must treat illnesses beginning at younger ages. Even with intervention, premature mortality is common in populations experiencing earlier-onset disease, which, in turn, leads to a loss of productive years of life and destabilization of the social and economic system among communities who disproportionately experience these losses. In sum, these common scenarios can reverse the gains in life expectancy we have come to expect from our therapeutic advances. Many of these issues are addressed in the article by Breathett and colleagues.9Whereas race is an important variable to study, we understand that most health disparities are related to social determinants of health rather than biological variables. Health is strongly determined by access to educational, social, and economic opportunities. These include the availability of resources to meet basic needs such as safe housing and access to healthy foods, education, and job opportunities which affect economic prospects, access to quality health care, and socioeconomic conditions such as poverty. Important social determinants of health that are finally receiving deserved attention are discrimination and racism.To move the needle toward health equity we must disseminate effective solutions for improving cardiovascular health. The articles by Kazi and colleagues10 and Bryant et al11, explore community-based interventions using novel strategies to address health care disparities.Ultimately, the use of race in research is framed by the perspectives of the stakeholders, including, but not limited to, community members, researchers, policy makers, patients, and funders. For example, a health policy stakeholder may need to differentiate sociodemographic categories by geography and race/ethnicity to rapidly implement policies aimed at improving identified population health needs, whereas genetic researchers might use targeted precision genomic approaches using a reductionist approach. In addition, persons belonging to vulnerable race/ethnic communities may see race as an extremely important aspect of their identity and consequently desire inclusion of race in their characterization. Thus, the lens through which different stakeholders view race is anchored by respective experiences, needs, and perspectives that dictate how or whether race is used in their work. Therefore, in addition to characterizing race as a social construct in all arenas, we must also be respectful of viewpoints and creativity brought to the table by different stakeholders who are collectively committed to achieving and sustaining health equity. In this inaugural issue focusing on disparity, you will see thoughtful and piercing Perspectives, Editorials, and Pathways to Discovery articles from scholars in the field such as Drs Clyde Yancy, Hannah Valentine, George Mensah, and several others.Last, on an historical note, this inaugural issue highlighting cardiovascular disease disparities in Black Americans is being published in June, in honor of Juneteenth. Juneteenth is an unofficial US holiday commemorating June 19, 1865, the day that Union soldiers delivered the news to enslaved persons in Galveston, Texas, that the war had ended and that slavery had been abolished more than 2 years earlier. Several explanations have been postulated for the two-and-a-half-year delay, and the true version may never be known, but Juneteenth pinpoints the end of the unthinkable injustice of slavery in the United States. In this disparities issue, we highlight injustices and disparities in health care and look for solutions toward ending them. This is imperative, for as Dr Martin Luther King, Jr, most eloquently stated, "Of all the forms of inequality, injustice in health is the most shocking and the most inhuman."12Sources of FundingNone.Disclosures None.FootnotesFor Sources of Funding and Disclosures, see page 2320.https://www.ahajournals.org/journal/circCorrespondence to: Karol E. Watson, MD, PhD, Division of Cardiology, David Geffen School of Medicine at UCLA Health Sciences, 650 Charles E. Young Dr, South A2-237 CHS MC #167917, Los Angeles, CA 90095-7103. Email [email protected]ucla.eduReferences1. Carnethon MRPu JHoward GAlbert MAAnderson CAMBertoni AGMujahid MSPalaniappan LTaylor HAWillis M, et al.; American Heart Association Council on Epidemiology and Prevention, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Functional Genomics and Translational Biology, and Stroke Council. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association.Circulation. 2017; 13621e393–e423. doi:10.1161/CIR.0000000000000534LinkGoogle Scholar2. Rodriguez FSolomon Nde Lemos JADas SRMorrow DABradley SMElkind MSVWilliams JH 4thHolmes DMatsouaka RA, et al.; Racial and ethnic differences in presentation and outcomes for patients hospitalized with COVID-19: findings from the American Heart Association's COVID-19 Cardiovascular Disease Registry.Circulation. 2021; 143:2332–2342. doi: 10.1161/CIRCULATIONAHA.120.052278LinkGoogle Scholar3. Wadhera RKFigueroa JFRodriguez FLiu MTian WKazi DSSong YYeh RWJoynt Maddox KERacial and ethnic disparities in heart and cerebrovascular disease deaths during the COVID-19 pandemic in the United States.Circulation. 2021; 143:2346–2354. doi: 10.1161/CIRCULATIONAHA.121.054378LinkGoogle Scholar4. Whitehead MDahlgren G; World Health Organization. Levelling up (part 1): a discussion paper on concepts and principles for tackling social inequities in health. Copenhagen: WHO Regional Office for Europe; 2006. https://apps.who.int/iris/handle/10665/107790Google Scholar5. Merriam-Webster Dictionary.Accessed May 21, 2021. https://www.merriam-webster.com/dictionary/raceGoogle Scholar6. Joseph JJPohlman NKZhao SKline DBrock GEchouffo-Tcheugui JBSims MEffoe VSWu W-CKalyani RR, et al.; Association of serum aldosterone and plasma renin activity with ambulatory blood pressure in African Americans: the Jackson Heart Study.Circulation. 2021; 143:2355–2366. doi: 10.1161/CIRCULATIONAHA.120.050896LinkGoogle Scholar7. Morris AATestani JMButler J. Sodium-glucose cotransporter-2 inhibitors in heart failure: racial differences and a potential for reducing disparities.Circulation. 2021; 143:2329–2331. doi: 10.1161/CIRCULATIONAHA.120.052821LinkGoogle Scholar8. Segar MWJaeger BCPatel KVNambi VNdumele CECorrea AButler JChandra AAyers CRao S, et al.; Development and validation of machine learning-based race-specific models to predict 10-year risk of heart failure: a multicohort analysis.Circulation. 2021; 143:2370–2383. doi: 10.1161/CIRCULATIONAHA.120.053134LinkGoogle Scholar9. Breathett KKnapp SMCarnes MCalhoun ESweitzer NK. Imbalance in heart transplant to heart failure mortality ratio among African American, Hispanic, and White patients.Circulation. 2021; 143:2412–2414. doi: 10.1161/CIRCULATIONAHA.120.052254LinkGoogle Scholar10. Kazi DSWei PCPenko JBellows BKCoxson PBryant KBFontil VBlyler CALyles CLynch K, et al.; Scaling up pharmacist-led blood pressure control programs in black barbershops: projected population health impact and value.Circulation. 2021; 143:2406–2408. doi: 10.1161/CIRCULATIONAHA.120.051782LinkGoogle Scholar11. Bryant KBMoran AEKazi DSZhang YPenko JRuiz-Negrón NCoxson PBlyler CALynch KCohen LP, et al.; Cost-effectiveness of hypertension treatment by pharmacists in black barbershops.Circulation. 2021; 143:2384–2394. doi: 10.1161/CIRCULATIONAHA.120.051683LinkGoogle Scholar12. Galarneau C. Getting King's Words Right.J Health Care Poor Underserved. 2018; 29:5–8. doi:10.1353/hpu.2018.0001CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited ByNichols M, Magwood G, Woodbury M, Brown K, Jenkins C and Owolabi M (2022) Crafting Community-Based Participatory Research Stroke Interventions, Stroke, 53:3, (680-688), Online publication date: 1-Mar-2022. June 15, 2021Vol 143, Issue 24Article InformationMetrics © 2021 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.121.055565PMID: 34125568 Originally publishedJune 14, 2021 PDF download Advertisement SubjectsDisparities
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