DALLAS, March 3, 2021 -- The association between race and ethnicity and specific characteristics of some U.S. counties may have a significant impact on death rates related to cardiovascular disease, according to new research published today in the Journal of the American Heart Association , an open access journal of the American Heart Association.
Cardiovascular disease is the leading cause of death in the U.S. across all racial and ethnic groups, and disparities in cardiovascular outcomes for racial and ethnic minority groups have been documented extensively. This study presents a detailed analysis of county-level predictors of cardiovascular death rates among white, Hispanic/Latinx and Black populations.
Using 2017 data from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) and the 2017 Robert Wood Johnson County Health Rankings, researchers evaluated variations in cardiovascular disease death rates among racial and ethnic groups and the degree to which county factors accounted for differences in death rates.
The county-level factors, some known as social determinants of health, analyzed:
Researchers used regression models to determine the association between each of the county-level factors and cardiovascular age-adjusted death rates for each race/ethnicity. They also assessed the factor that accounted for the greatest variation in death rates.
Among the study's key findings:
These results may help develop and implement effective interventions to improve cardiovascular outcomes, said co-lead study author Justin Parizo, M.D., an advanced heart failure and transplant cardiology fellow at Stanford University in Stanford, California.
"Currently, population and community-level health interventions are typically focused on disease and medical risk factors, however, our analysis suggests that more emphasis may need to be placed on intervention that can improve social determinants of health, particularly for Black people," Parizo said. "As examples, several trials have shown that income supplementation in addition to nutritional counseling can improve diet among populations at risk for cardiovascular disease. Additionally, interventions to improve housing have been shown to increase patient exercise levels and, in the long term, could decrease unhealthy outcomes such as obesity and Type 2 diabetes."
Because the research is observational and retrospective, the findings cannot prove cause and effect. Another limitation of the study is the interpretation of the county-level risk factors, which do not necessarily describe subpopulations within each county. "For example, a 40% obesity rate among Black people in a county represents the entire Black population but does not necessarily hold true for every subgroup of the Black population," Parizo said.
"This study's greatest value is that it informs the understanding of cardiovascular population health and the numerous factors that play a role in cardiovascular health," said co-senior study author Fátima Rodriguez, M.D., M.P.H., assistant professor of cardiovascular medicine and a preventive cardiologist and health disparities researcher at the Stanford Prevention Center at Stanford University School of Medicine. "Not all populations are the same. Nuanced understanding of the unique influences on cardiovascular outcomes is essential to narrow disparities for various population groups."
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Additional co-authors are Bongeka Z. Zuma, M.Sc.; Areli Valencia, B.A.; Gabriela Spencer-Bonilla, M.D., M.Sc.; Manuel R. Blum, M.D., M.Sc.; and David Scheinker, Ph.D.
The study was funded by the Stanford Medical Scholars Fellowship Program; the National Heart, Lung, and Blood Institute of the National Institutes of Health; and the American Heart Association/Robert Wood Johnson Harold Amos Medical Faculty Development Program.
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https://newsroom.heart.org/news/county-where-people-live-may-predict-some-cardiovascular-death-by-race-ethnicity?preview=0508311c6d6a673496dc526aeafc350f
After March 3, view the manuscript online.
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