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Health Disparities in Cardiovascular Disease

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

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  1. 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

  2. Source: AHA, Heart Facts 2004: African Americans

  3. 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

  4. 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

  5. Source: MDPH, 2001 Mortality Records

  6. Source: MDPH, Massachusetts Deaths, 2001

  7. Source: CDC/NCHS Health, United States, 2003

  8. Stroke • 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

  9. Source: MDPH, Massachusetts Deaths, 2001

  10. Source: MDPH, Massachusetts Deaths, 2001

  11. Risk Factors 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

  12. Overweight and obesity • 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

  13. Overweight Obesity Source: MDPH, BRFSS, A Profile of Health Among Massachusetts Adults, 2002

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

  15. Physical Inactivity • 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

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

  17. Diabetes • 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

  18. Source: MDPH, Massachusetts Hospital Discharge Data, Fiscal Year 2001

  19. Cigarette Smoking • Cigarette smoking rates are similar among white and black residents of Massachusetts • Whites are more likely to quit smoking than blacks

  20. Source: MDPH, 2000 Behavioral Risk Factor Surveillance Survey

  21. High Blood Pressure (Hypertension) • 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

  22. Source: MDPH, Massachusetts Hospital Discharge Data, Fiscal Year 2001

  23. High Blood Cholesterol • 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

  24. Source: CDC/MDPH, BRFSS 2001

  25. Screening & Treatment • 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))

  26. Policy Considerations • 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

  27. Contact Information 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: PAJohnson@partners.org 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: rwilson1@partners.org

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