Racial disparities in health care, cardiovascular outcomes

Black and Latinx communities were more likely to be infected by the coronavirus and more than twice as likely to die from COVID-19 than their white counterparts over the past 18 months, putting long-standing and well-documented racial disparities in health outcomes on display.

According to the U.S. Centers for Disease Control and Prevention (CDC), racial and ethnic minority groups have been disproportionately represented among COVID-19 cases and more likely to be hospitalized and die from the virus. Though the COVID-19 pandemic highlighted health disparities and put racial inequity in the spotlight, the issues and outcomes date back generations and persist in the U.S. health care system and specifically in heart and cardiovascular care.

“We’ve known about this for a long time,” Dr. Jeffrey Alexis, medical director of the University of Rochester Medical Center’s mechanical circulatory support program, said of health and heart care disparities. “There’s kind of been a renewed focus on this over the past year and a half or so and certainly part of that was based on COVID-19 and disparities we saw in terms of who got sick and the outcomes of those who became sick.”

Dr. Linda Clark, chief medical officer of Rochester-based Common Ground Health, said there is “a huge disparity by race” when it comes to cardiovascular disorders, noting there are incongruities in outcomes between Black Americans and white Americans in everything from high blood pressure to heart disease and stroke.

Common Ground, a Rochester-based agency aimed at finding collaborative solutions to community health issues, recently published The Color of Health: The Devastating Toll of Racism on Black Lives, a report highlighting racial disparities in health outcomes. The nearly 30-page report documents the impact of racism on the health care system and its effect on Black patients.

The Common Ground report also noted heart disease is the top cause of premature mortality in the region’s Black population.

The existence of racial disparities in health outcomes is well documented, according to Clark, and the questions Common Ground and others are trying to answer are why the disparities persist and how the gaps in outcomes can be closed. Unfortunately, all the answers are not known, but Clark said there are some clues that largely point to factors outside the exam room and genetics.

Examining why the racial disparities exist in heart health is complicated, Alexis said, noting diabetes, hypertension or high blood pressure, obesity and other common risk factors are more prevalent in Black patients and in part lead to disparate outcomes.

Medical experts and researchers have come to realize that those risk factors are not the only factors leading to disparities in outcomes, Alexis said, pointing to social determinants of health as another major factor in outcomes.

“Part of it is risk factors but there’s a lot of social determinants. There’s racism, there’s a lack of minority physicians, issues with mistrust and issues with a lack of health care,” Alexis said, citing food insecurity, violence, physical activity, alcohol use and environmental stress as other examples of social determinants.

The CDC describes social determinants as the conditions in the places where people live, work, play and worship that impact a wide range of health risks and outcomes. The CDC notes social determinants of health have historically prevented racial and ethnic minority groups from having fair opportunities for economic, physical and emotional health.

Clark also pointed to social determinants as a driving factor in health outcomes and racial disparities.

“We can talk all day bout getting in your 30 minutes of exercise five days a week, but we can’t talk about it without talking about a healthy environment or where you can get healthy foods,” Clark said. “We can’t talk about it without understanding that lower income doesn’t allow you to go to the gym, etc.”

Socioeconomic factors are closely related to and overlap with social determinants, Alexis said, but the two are not entirely the same. Alexis said in terms of food insecurity, some individuals and families may not be able to afford food while others may just not have access to healthful food options.

With some light shed on the reasons why racial inequities exist in health and heart care, the medical community and agencies like Common Ground are trying to make a difference and bring equity to health care.

Good preventive health care is “only a piece of the puzzle,” according to Clark. She said health care professionals must be prepared to give solid preventative recommendations but outside factors — including health insurance coverage, availability of health care and financial resources — still have a significant impact on health outcomes and must be addressed.

“It takes a network of other experts out in the community to help with good, healthy messages,” Clark said, pointing to a Common Ground partnership with the Interdenominational Health Ministry Coalition to educate individuals on preventative health. “When you’re in church and your health ministry is talking to you about blood pressure, and taking your blood pressure, that has a totally different impact than it might at the doctor’s office.”

Clark said the health ministry and other community health educators connected to the community are an important part of an overall system to improve health outcomes. Common Ground has other programs that work with barber shops and beauty salons, along with a team of ambassadors working on COVID-19, that engage with the community and reinforce health messaging.

Closing racial disparities in health care starts with children, Clark said, pointing out there are critical milestones in development between birth and age 2. She said teaching children the importance of taking care of physical, emotional, dental and other health at a very early age is vital to lifelong health.

“If we’re not looking at people from birth on up, we’re too late by the time they get to my office for their first work physical,” Clark said. “We are very interested in good, playful environments for children. And we understand how critical play is in learning how to think and reason, in addition to good physical health.”

Clark also said access to healthy foods is key, noting improved access to healthy fruits and vegetables is important to overall health. Addressing tobacco use, which remains a significant driver of heart disease, is also critical, she said.

Alexis said improving access to health care is also critical to improving outcomes, along with education, addressing medical mistrust and research and study of health inequities. Some of those tasks are “not straightforward” and easier said than done, Alexis noted, but the medical community is now starting to recognize the issues.

Addressing the social determinants that negatively impact outcomes is critical, Alexis said, conceding those are complicated issues that will not be corrected overnight.

“Focusing on social determinants is important to do but that is also not straightforward. What do you do to treat violence? What do you do in terms of issues of food insecurity and physical activity? These are very tough areas, and we are starting to discuss them with patients and at least identify them, so that’s a start,” Alexis said. “But then how do you act upon that?”

Matthew Reitz is a Rochester-area freelance writer.