The Role of Geography and Race in Cardiovascular Disease

Research reveals that where you live may affect your chances of dying from a stroke or heart disease.

There are still hot spots nationwide where these mortality rates are unusually high. Poverty and lack of access to quality care can condemn many Americans to an early death.

Two main factors appear to be driving the differences in cardiovascular disease risks.

One is exposure to risks that cause stroke and cardiovascular diseases, such as high blood pressure, poor diet, high cholesterol, obesity, and smoking. The other is the lack of access to good primary and hospital care.

THE ROLE OF GEOGRAPHY IN CARDIOVASCULAR DISEASE

To estimate death rates from cardiovascular disease, researchers selected death records from more than three thousand and one hundred counties in the United States.

The death rate from cardiovascular disease declined by fifty percent between 1980 and 2014, from 507 deaths per 100,000 individuals to 253 deaths per 100,000 individuals.

Nevertheless, across the country, substantial differences between counties were evident. Significant differences also existed for heart failure, artery and vein disease, atrial fibrillation, and other heart-related conditions.

The counties with the highest death rates from cardiovascular disease were in a swath extending from Southeastern Oklahoma along the Mississippi River valley to eastern Kentucky.

Outside the South, several clusters in which cardiovascular disease rates were high included the following:

• High rates of atrial fibrillation in the Northwest
• Aortic aneurysm in the Midwest
• Endocarditis in the Mountain West and Alaska

You can find the lowest death rates from cardiovascular disease in counties around San Francisco and central Colorado, northern Nebraska, central Minnesota, northeastern Virginia, and southern Florida.

Even in states where individuals think they are relatively healthy, you can still find places where individuals are unhealthy.

Hopefully, we may use these data to identify areas where mortality rates are high and improve health care and lifestyle interventions to reduce deaths from cardiovascular disease.

The above research should remind us of the crucial role that social aspects play in health, including environment, educational factors, and social and economic status.

Disparities between counties are likely due to the prevalence of risk factors and differences in access to quality care.

Decreasing death rates from heart attack and stroke in the United States may obscure many essential details about who benefits and who does not benefit from such trends.

THE ROLE OF RACE AND ETHNICITY IN CARDIOVASCULAR DISEASE

Heart disease is the primary cause of death for adults in the United States. Yet, it affects some individuals, especially minority groups, more strongly than others. For example, healthcare providers diagnosed 47% of black adults compared to 36% of white adults.

Regarding cardiovascular disease risk factors, racial and ethnic minority groups bear a heavier burden. For example, Hispanic women are twice as likely as white women to have diabetes, a significant risk factor for heart disease. In addition, American Indians are three times more likely than white people to have diabetes.

Risk factors and diagnoses of cardiovascular disease are more frequent among ethnic minorities. Social factors, known as “social determinants of health,” drive these health disparities.

HEALTH INEQUALITIES

Health inequalities or disparities exist because of differences between racial and ethnic groups. These inequalities are a complex and challenging problem in the United States and worldwide.

Researchers view race and ethnicity as social constructions rather than biological traits, meaning that genetics do not cause health differences between racial and ethnic groups. Instead, social factors play the most significant role in shaping an individual’s health.

Many social factors affect an individual’s health. Some crucial factors include  an individual’s ability to access the following:

• Quality education
• Money and resources for the necessities of life
• Quality health
• Resources such as nutritious food and vegetables and fruits
• A safe living environment, for example, water and clean air
• Supportive relationships free from violence and discrimination

These factors, which are the “social determinants of health,” connect. For example, poverty can prevent individuals from eating a heart-healthy diet. Likewise, if those individuals live without healthy food choices, their options are even more limited.

Unfortunately, social factors disadvantage blacks, Hispanics, and American Indians. These groups frequently bear a heavier economic and social burden. As a result, their health also suffers. Other groups also face disadvantages that affect their risk of cardiovascular disease.

DO CARDIOVASCULAR DISEASE RISKS DIFFER BY RACE AND ETHNICITY?

Hypertension (high blood pressure) and type 2 diabetes affect certain racial and ethnic groups in the United States, the two major risk factors for cardiovascular disease.

–HYPERTENSION OR HIGH BLOOD PRESSURE

• Fifty-nine percent of black adults suffer from hypertension. This percentage is the highest prevalence among all racial and ethnic groups.
• Four out of five Asian adults in treatment still have uncontrolled hypertension. This number somewhat reduces for Hispanic and black adults (three out of four for each group).
• Black women are twice as prone as white women to develop chronic hypertension during pregnancy. This condition increases an individual’s risk of cardiovascular disease in the future.
• Black adults are more susceptible than white adults to suffer organ damage because of hypertension. Consequently, they are four times more likely to experience end-stage renal disease.
• Black adults are more predisposed than white adults to die from hypertension and related diseases.

Social factors impact these numbers. For example, individuals who do not have insurance are more prone to uncontrolled hypertension. In addition, individuals who face discrimination suffer from higher blood pressure.

Hypertension (high blood pressure) may lead to complications, including the following:

• Heart failure
• Coronary artery disease
• Peripheral arterial disease
• Stroke
• Chronic and end-stage renal disease (kidney disease)
• Abdominal aortic aneurysm
• Dementia

–TYPE 2 DIABETES

Type 2 diabetes may damage blood vessels in the heart, kidneys, and brain. This condition also causes triglyceride and LDL cholesterol levels to rise. As a result, individuals with diabetes are twice as prone as those without diabetes to have a stroke or heart attack.

Approximately one in ten individuals in the United States has diabetes, and ninety to ninety-five percent suffer from type 2 diabetes. Diabetes is an urgent health crisis for all individuals. Yet, it affects some racial and ethnic groups more frequently.

Some researchers identify diabetes as an exemplary disease of health inequality. That is, differences between racial and ethnic groups are evident in the data. And social factors drive them. For example, some racial and ethnic disparities in diabetes prevalence include the following:

• Among American Indians, one in four has diabetes, compared with one in twelve whites.
• Latins, black, and Asian American adults are more prone than white adults to develop diabetes.
• Blacks are younger than whites when healthcare providers diagnose them with diabetes. As a result, they have a shorter life expectancy.
• Latin individuals are twice as prone as white individuals to have undiagnosed diabetes because they do not always have health insurance and routine medical care.
• Latin women are more than twice as prone as white women to have diabetes.
• Type 2 diabetes usually affects adults over the age of forty-five. But research shows it is becoming more frequent among young adults and children.
• Latin and African-American children had the most significant increase in diagnoses between 2022 and 2015.
• Obesity increases an individual’s risk of developing type 2 diabetes. Obesity is increasingly causing diabetes among Asian Americans, African Americans, and Latins.
• Black adults have the highest prevalence of severe obesity (a Body Mass Index (BMI) of at least forty).

ETHNIC GROUP WITH THE HIGHEST RATE OF CARDIOVASCULAR DISEASE

Heart disease rates fluctuate depending on the specific diagnosis. Next are some insights from research in the United States.

–HEART FAILURE

• Black men have a seventy percent higher risk of heart failure compared to white men
• Black women have a fifty percent higher risk of heart failure compared to white women
• Black adults are more than twice as predisposed as white adults to go to the hospital for heart failure. They also spend more time in the hospital and are more prone to be readmitted within ninety days.
• Latin adults are more susceptible than white adults to heart failure

–HEART ATTACK AND CORONARY ARTERY DISEASE

• Black women are more susceptible than white women to experiencing a heart attack
• Black adults are more susceptible than white adults to die from a heart attack
• Asian adults are less prone than other groups to have coronary artery disease. But there are some differences by ethnicity. Asian Indian men and Filipino women and men are at higher risk than whites.
• Young Latin women who experience a heart attack risk dying more than young Latin men. They are also more prone to die than black and white young adults.

–STROKE

• Black adults are more susceptible to experiencing a stroke than other racial and ethnic groups. They are also likely to be younger.
• Black adults are more prone to die from stroke than whites.
• Mexican American adults are more susceptible than whites to having a stroke.
• One study showed that Filipino women are twice as prone as white women to experience a stroke. Vietnamese men and Korean women are more susceptible than their white counterparts to experiencing a hemorrhagic stroke.
• Filipino adults, Japanese and Vietnamese men, are more susceptible than white adults to die of stroke.

Some individuals face higher risks than others. For example, if you belong to a racial or ethnic group confronting health inequity, talk to your healthcare provider about your threats and options. In addition, it is essential to start young with checkups, getting your blood pressure, blood sugar, and cholesterol numbers.

You and your healthcare provider may work together to identify your risks and find ways to reduce them.

We are Modern Heart and Vascular Institute, a diagnostic and preventative medicine cardiology practice. For more information, contact us.