Cardiovascular Disease in Blacks Compared to Whites in Massachusetts

1. Cardiovascular Diseasein Blacks Compared to Whites in Massachusetts Abuchi Agu, Alexander Bogdan, Mellisa Deandrade, Haydy George, Jacqueline Tran Summer Enrichment Program 2013 University of Massachusetts Medical School

2. What is Cardiovascular Disease? • Cardiovascular disease is a class of diseases that involve the heart and the blood vessels (arteries, veins, capillaries). • Examples include: • Coronary Heart Disease • Cardiac dysrhythmia • Heart Failure • Congenital Heart Defects

3. Health Disparity • Defined as inequities in the quality of health care between groups as compared to the general population. These inequities influence how frequently a disease affects a certain group within the population . • Black individuals suffer from a signifcantly higher mortality rate from cardiovascular disease when compared to the white population. Source: MassCHIP

4. Why CVD? • Cardiovascular diseaseis the #1 killer in MA ofblack individuals • Blacks are 1.5 times more likely to die from CVD than their white counterparts in Worcester County. • Blacks are more likely to develop multiple risk factors for CVD Source: www.cdc.gov

5. Symptoms • Chest pain or discomfort • Shortness of breath • Cold sweat • Abnormal heart beats • Nausea • Light-headedness/ dizziness • Upper body discomfort in one or both arms, the neck, jaw, or stomach. • Unusual fatigue Source: www.nhlbi.nih.gov

6. 6 Genesis of Maladies • Despite universal health care, cost still presents a barrier to quality care • Many minority patients with primary care providers express difficulty communicating with doctors Source: Kaiser Family Foundation

7. Risk Factors

8. 8 Smoking • Blacks are less likely to quit smoking than whites. • Smoking prevalence is higher in individuals at or below the poverty line Source: MassCHIP

9. Physical Inactivity 9 Black individuals are 13.4% less active than the general population in US; 7.2% less active in Massachusetts Older black adults and those with low education and income levels are atgreatest risk for inactive lifestyles Source: A Profile of Health Among Massachusetts Adults, 2010

10. High Cholesterol 10 • Blacks are less often informed of high cholesterol • Due to cultural, dietary or genetic differences • A 10% decrease in cholesterol can translate to a 25% risk reduction for CVD Source: MassCHIP

11. Hypertension • Hypertension increases risk of CVD by nearly 4 times. • Prevalence of hypertension in blacks is highest in the world. • Hypertension leads to about 50% of ischaemic strokesand significantly increases risk of hemorrhagic stroke. • Blacks are less likely to have controlled blood pressure than whites. Source: MassCHIP

12. Obesity • Obesity is an independent risk factor for CVD • Blacks have a higher incidence of obesity than any other race/ethnic group • Proper diet and regular physical exercise can reduce this disparity Source: MassCHIP

13. Diabetes • Incidence of diabetes in black youths has increased dramatically in past 20 years • Adults diagnosed with diabetes are up to 4 times more likely to die of CVD • Smoking with diabetes doubles risk of developing CVD Source: MassCHIP

14. Diagnosis As reported by "Determinants of Black-White Differences in the Risk of Cerebral Infarction: The National Health and Nutrition Examination Survey Epidemiologic Follow-up Study” • Blacks are less likely to receive major procedures diagnosing CVD, especially coronary heart disease, than the white population. • Specifically, black women are the least likely to have these procedures recommended. • In the past, heart disease was thought to be rare in blacks, especially since they had low access to medical care, contributing to present disparity.

15. Treatment Fix graph • Common problems for blacks are cost of medication, necessity of a multiple-drug regimen, and theinconvenience of frequent follow-up visits. Source: www.city-data.com, Overview of the Uninsured in the United States: A Summary of the 2011 Current Population Survey

16. Current Efforts to Reduce CVD Disparity • HAPPY Hearts Program • Focus on low-income women • Offers screenings and aggressive primary prevention techniques • Effectively reduces incidence of metabolic syndrome, a strong predictor of CVD • Additional studies conductedto reducedisparity: • Control of psychosocial stress • Community education programs • Programs educating physicians to treat diverse populations

17. Summary of Findings 17 • There are many prevalent risk factors contributing to CVD • Disparities exist between black and white populations in all risk factors for CVD • Disparities also exist in socioeconomic status and accessibility to health care • Diagnostic inefficiency may be key to disparity prevalence

18. Conclusion 18 • Research suggests disparities in risk factors reinforce CVD disparity between blacks and whites • Economic inequality and accessibility of care further stigmatize CVD disparity • Investigation is needed into existence of diagnostic disparities and their resolution • Establishment of community-based primary prevention programs have been proven to reduce disparity

19. Braveman, P., Cubbin, C., Egerter, S., Williams, D., & Pamuk, E. (2010). Socioeconomic Disparities in Health in the United States: What the Patterns Tell Us. American Journal of Public Health, 100, 186-196. Retrieved June 10, 2013, fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2837459/ • Cardiovascular Health (n.d.). Mass.Gov. Retrieved June 8, 2013, from http://www.mass.gov/eohhs/researcher/community-health/masschip/topics/cardiovascular-health.html#state_total • Giles, W., Kittner, S., Hebel, R., Losonczy, K., & Sherwin, R. Determinants of black-white differences in t... [Arch Intern Med. 1995] - PubMed - NCBI. National Center for Biotechnology Information. Retrieved June 13, 2013, fromhttp://www.ncbi.nlm.nih.gov/pubmed/777896>. • Gilstrap, L., Malhotra, R., Peltier-Saxe, D., Slicas, D., Pineda, E., Culhane-Hermann, C. e., et al. (2013). Community-Based Primary Prevention Programs Decrease the Rate of Metabolic Syndrome Among Socioeconomically Disadvantaged Women. Journal Of Women's Health, 22(4), 322-329. • Heart disease - MayoClinic.com. (2011, August 2). Mayo Clinic. Retrieved June 7, 2013, from http://www.mayoclinic.com/health/heart-disease/DS01120 • Keppel, K., Pearcy, J., & Heron, M. (2010). Is There Progress Toward Eliminating Racial/Ethnic Disparities in the Leading Causes of Death?. Public Health Reports, 125(5), 689-697. Retrieved June 5, 2013, fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925005/ • Lutfey, K. E., Eva, K. W., Gerstenberger, E., Link, C. L., & McKinlay, J. B. (2010). Physician Cognitive Processing As A Source Of Diagnostic And Treatment Disparities In Coronary Heart Disease: Results Of A Factorial Priming Experiment. Journal of Health and Social Behavior, 51(1), 16-29. • Mathieu, R., Powell-Wiley, T., Ayers, C., McGuire, D., Khera, A., Das, S., et al. (2012). Physical Activity Participation, Health Perceptions, and CVD Mortality in a Multi-Ethnic Population: The Dallas Heart Study. American Heart Journal, 163(6), 1037-1040. Retrieved June 8, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514075/ • Schneider, R., Grim, C., Rainforth, M., Kotchen, T., Nidich, S., & Gaylord-King, C. (2012). Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks. . PubMed, 5(6), 750-758. Retrieved June 11, 2013, from http://www.ncbi.nlm.nih.gov/pubmed/23149426 • Why Blood Pressure Matters. (2012, April 4). American Heart Association. Retrieved June 14, 2013, from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/WhyBloodPressureMatters/Why-Blood-Pressure-Matters_UCM_002051_Article.jsp • Who Is at Risk for High Blood Pressure? - NHLBI, NIH. (2012, August 2). NIH Heart, Lung and Blood Institute. Retrieved June 14, 2013, from http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/atrisk.html • Yancy, C., Wang, T., Ventura, H., Pina, I., Vijayaraghavan, K., Ferdinand, K., et al. (2011). The Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Disease Outcomes (credo). Journal of the American College of Cardiology, 57(3), 245-252. Retrieved June 11, 2013, fromhttp://content.onlinejacc.org/article.aspx?articleid=1144069 • Yoon, S. S., Burt, V., Louis, T., & Carroll, M. (n.d.). Products - Data Briefs - Number 107 - October 2012. Centers for Disease Control and Prevention. Retrieved June 10, 2013, from http://www.cdc.gov/nchs/data/databriefs/db107.htm References

20. Albelda, R., Cadet, F., & Mei, D. (2011, May 1). Poverty in Massachusetts by Race. ScholarWorks - University of Massachusetts Boston. Retrieved June 12, 2013, from scholarworks.umb.edu/csp_pubs/56/ • CDC - Fact Sheet - Fast Facts - Smoking & Tobacco Use. (2013, June 5). Centers for Disease Control and Prevention. Retrieved June 10, 2013, fromhttp://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/#use • Carroll, W. (2011, March 1). Hypertension in America: Estimates for the U.S. Civilian Noninstitutionalized Population, Age 18 and Older, 2008. Statistical Brief #315. Retrieved June 10, 2013, from \http://meps.ahrq.gov/data_files/publications/st315/stat315.pdf • DeNavas, C., Proctor, B., & Smith, J. (2010, September 1). Income, Poverty, and Health Insurance Coverage in the United States: 2009. United States Census Bureau. Retrieved June 8, 2013, fromwww.census.gov/prod/2010pubs/p60-238.pdf • Diabetes . (2010, December 7). Mass.Gov. Retrieved June 13, 2013, fromhttp://www.mass.gov/eohhs/researcher/community-health/masschip/topics/diabetes.html#state_total • Health Care Access and Screening Indicators . (2010, December 6).Mass.Gov . Retrieved June 6, 2013, fromhttp://www.mass.gov/eohhs/researcher/community-health/masschip/topics/health-care-access-and-screening-indicators.html • Holmes, J., & Madans, J. (2012). Health, United States, 2012: With Special Feature on Emergency Care. National Center for Health Statistics, 1. Retrieved June 8, 2013, fromhttp://www.cdc.gov/nchs/data/hus/hus12.pdf#065 • McKenna, M., Clifford, C., Gonsalves, D., Hawk, H., & Tinsley, L. (2010). Health Survey Program. A Profile of Health Among Massachusetts Adults, 2010, 1. Retrieved June 10, 2013, fromhttp://www.mass.gov/eohhs/docs/dph/behavioral-risk/report-2010.pdf • Minority Health | The Henry J. Kaiser Family Foundation. (n.d.). Kaiser Family Foundation - Health Policy Research, Analysis, Polling, Facts, Data and Journalism. Retrieved June 5, 2013, fromhttp://kff.org/state-category/minority-health/?state=MA • Overview of the Uninsured in the United States: A Summary of the 2011 Current Population Survey. (2011, September 1).ASPE. Retrieved June 10, 2013, fromhttp://aspe.hhs.gov/health/reports/2011/cpshealthins2011/ib.shtml • QUICK FACTS on physical inactivity | World Heart Federation. (n.d.). World Heart Federation | Home. Retrieved June 9, 2013, http://www.world-heart-federation.org/press/fact-sheets/cardiovascular-disease-risk-factors/quick-facts-on-physical-inactivity/ • Race/Hispanic Ethnicity Report - Health Risk Factors . (2010, December 6).Mass.Gov . Retrieved June 6, 2013, fromhttp://www.mass.gov/eohhs/researcher/community-health/masschip/topics/health-risk-factors-racehispanic-ethnicity-report.html • Smoking . (2010, December 6). Mass.Gov. Retrieved June 7, 2013, fromhttp://www.mass.gov/eohhs/researcher/community-health/masschip/topics/smoking.html • Worcester, Massachusetts (MA) poverty rate data - information about poor and low income residents living in this city. (2009, November 19). Stats about all US cities - real estate, relocation info, crime, house prices, cost of living, races, home value estimator, recent sales, income, photos, schools, maps, weather, neighborhoods, and more. Retrieved June 13, 2013, fromhttp://www.city-data.com/poverty/poverty-Worcester-Massachusetts.html