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Health Disparities in Cardiovascular Disease. Paula A. Johnson, MD, MPH Chief, Division of Women’s Health; Executive Director, Connors Center for Women’s Health & Gender Biology, Brigham and Women’s Hospital. Brigham and Women’s Hospital. Source: AHA, Heart Facts 2004: African Americans.

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Health Disparities in Cardiovascular Disease

Paula A. Johnson, MD, MPH

Chief, Division of Women’s Health;

Executive Director, Connors Center for Women’s Health & Gender Biology,

Brigham and Women’s Hospital

Brigham and

Women’s Hospital

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Why Cardiovascular Disease?

  • By preventing CVD among African Americans and decreasing disparities, we address:

    • Access to care/equality

    • Biologic differences

    • Environmental issues

      • Stress

      • Racism

      • Environmental/contextual challenges to healthy behaviors

    • Prevention of other chronic diseases

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Cardiovascular Disease (CVD) in Massachusetts and the United States

  • CVD, primarily coronary heart disease and stroke, is the leading cause of death for MA blacks and whites, accounting for over 15,000 or about 27% of MA deaths in 2001

  • In 2001, rates CVD deaths in MA were 18% higher for blacks than whites

  • Black women tend to develop heart disease at an earlier age and have the highest mortality rate from heart disease of all women

  • The National Heart Lung and Blood Institute estimates that cardiovascular disease will cost the U.S. $368.4 billion in 2004 in direct and indirect costs

Sources: MDPH, CDC

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Stroke States

  • Stroke is the third leading cause of death in MA, accounting for 3,534 deaths or about 6% of all deaths in 2001

  • In 2001, MA blacks were 33% more likely to die of stroke than whites; most of this difference is accounted for by disparities among women, with black women 37% more likely to die from stroke than white women

Source: MDPH, MA Deaths, 2001

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Risk Factors States

Approximately 80% of cardiovascular disease is preventable.

Risk factors for CVD include:

  • Overweight and obesity

  • Physical inactivity

  • Diabetes

  • Cigarette smoking

  • High blood pressure

  • High blood cholesterol

  • Family History

  • Age

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Overweight and obesity States

  • Black adults are more likely than all other race/ethnicity groups to be overweight

  • Significant disparities exist among women; in 2000, black women were 56% more likely to report being obese or overweight than white women in Massachusetts

  • Factors that are particularly important include physical activity and a healthy diet

  • The relationship between stress and obesity is being explored and may have particular relevance for the black community

Sources: US DHHS, MDPH BRFSS 2000

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Overweight States


Source: MDPH, BRFSS, A Profile of Health Among Massachusetts Adults, 2002

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Physical Inactivity Adults, 2002

  • Physical inactivity is more prevalent among African-Americans than whites

  • In Massachusetts in 2002, blacks were 21% less likely than whites to report physical activity in the previous month

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Diabetes Adults, 2002

  • Adults with diabetes are 2-4 times as likely to die of heart disease than those without diabetes

  • In 2001, Massachusetts blacks were 3.2 times more likely to be discharged from a hospital with a diagnosis of diabetes than whites

  • The prevalence of diabetes among blacks in the U.S. has quadrupled during the past 30 years, with increasing incidence in black youths

  • Approximately 2.7 million or 11.4% of all African Americans aged 20 years or older have diabetes, but one-third of them are unaware of their diagnosis

Sources: ADA, CDC

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Cigarette Smoking Year 2001

  • Cigarette smoking rates are similar among white and black residents of Massachusetts

  • Whites are more likely to quit smoking than blacks

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High Blood Pressure (Hypertension) Survey

  • Those with high blood pressure may have 3-4 times the risk of CHD and 7 times the risk of stroke than those with normal blood pressure

  • The prevalence of high blood pressure among U.S. blacks is among the highest in the world

  • Blacks are more likely to develop high blood pressure at an earlier age and to have higher blood pressure than whites

  • Black women in the U.S. have the highest incidence of hypertension of any race-sex group

  • Blacks are less likely to have their hypertension controlled than whites, with black women being the least likely (He J et al, Arch Intern Med, 2002;162)

Source: US DHHS

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High Blood Cholesterol Year 2001

  • Among African Americans in the U.S., 45% of men and 46% of women have high blood cholesterol

  • A 10% decrease in total cholesterol levels may result in an estimated 30% reduction in the incidence of coronary heart disease

  • Blacks tend to have lower blood cholesterol levels than whites

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Screening & Treatment Year 2001

  • Blacks are less likely to receive major procedures diagnosing and treating coronary heart disease than whites

  • Black women are the least likely to have such procedures recommended

    Sources: Schulman KA et al, N Engl J Med 1999;340(8); Ayanian JZ et al, JAMA, 1993;269,20; Giles et al, Arch Intern Med 1995;155(3); Johnson PA et al, Ann Intern Med 1993;119(8))

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Policy Considerations Year 2001

  • Access to medical care

  • Adoption of standards and guidelines for prevention, detection, treatment and rehabilitation of heart disease for all patients

  • Physician diversity and resident training in cultural and gender competence

  • Re-investment in tobacco prevention and cessation initiatives

  • Improved access to high quality, heart healthy foods, especially in rural and urban low-income areas

  • Increased access to safe walking/activity areas and promotion of innovative strategies to facilitate exercise time

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Contact Information Year 2001

Paula A. Johnson, MD, MPH

Chief, Division of Women’s Health; Executive Director, Connors Center for Women’s Health and Gender Biology

Brigham and Women’s Hospital

Phone: (617) 732-8985, Fax: 264-5191

Email: [email protected]

Rachel A. Wilson, MPH

Director of Women’s Health Policy and Advocacy

Brigham and Women’s Hospital

Phone: (617) 525-7516, Fax: (617) 525-7746

Email: [email protected]