Cardiovascular death rate in the United States varies by county
- Deaths from cardiovascular disease (CVD) in the United States have declined steadily over the past four decades.
- However, the authors of a recent study argue that systemic racism underlies the persistent health inequality in U.S. counties.
- Their research underscores the urgency of addressing behavioral and social risk factors to close the gap in heart health outcomes.
The United States has seen a decrease in death rates from cardiovascular disease over the past 40 years. However, scientists at the University of Texas (UT) Southwestern Medical Center in Dallas have found stark disparities between areas with high and low mortality.
The team presented their preliminary research at the American Heart Association’s (AHA) Epidemiology, Prevention, Lifestyle & Cardiometabolic Health conference on May 20, 2021.
Researchers looked at data collected between 1980 and 2014 in 3,133 U.S. counties. CVD-related deaths included all deaths attributed to cardiovascular causes on death certificates.
They targeted the data at the county level, as this is where many decision makers make public health policies.
Using an approach based on the ClustMixType algorithm produced three distinct groups of counties based on CVD-mortality trajectories over the timeline of the study.
The “high mortality” counties had a baseline of about 60 CVD deaths per 10,000 population. The “intermediate mortality” and “low mortality” clusters had a baseline of 50 and 40 CVD deaths per 10,000 population, respectively.
The researchers compared these statistics with demographic, environmental and health markers at the county level. These data included crime rates, vacant homes, smoking, diabetes, obesity and food shortage.
The analysis revealed parallel declines in CVD deaths in all groups.
However, Dr. Shreya Rao, lead author of the study and researcher at UT Southwestern Medical Center in Dallas, said:
“We were surprised to find that although CVD death rates have improved across the country, including in areas with some of the highest and lowest rates, the relative differences between county groups and the existing disparities between counties have not changed. “
The regions with the lowest CVD mortality included counties in the Northwest, Great Plains, Midwest, Northeast, and Florida.
The regions of the South Atlantic, Deep South, and parts of the Appalachian States had the highest death rates.
Dr Rao notes: “The counties with high mortality were much more clustered and centered on areas known to have high rates of chronic diseases, such as heart disease, stroke, high blood pressure, type diabetes. 2 and obesity. ”
The study found that the counties most affected by mortality had higher non-white populations. These areas also experienced low high school completion rates, higher violent crime, and higher vacant housing.
He found that education, violent crime rates, and smoking were the strongest predictors of being in the high mortality subgroup.
UT researchers note that public health agencies generally do not view social problems as controllable risk factors for CVD. Nonetheless, the study’s authors believe that these problems have an impact on long-term health.
Dr Rao observed an “inextricable” correlation between social and economic distress and poor health indicators.
Lead author of the study, Dr Ambarish Pandey, assistant professor of internal medicine at UT Southwestern Medical Center in Dallas, commented:
“For clinicians, it is very natural to focus on modifiable risk factors for our patients… [H]However, it is important to understand that some of an individual’s risk factors are not necessarily under their control. And some factors may be modifiable through public policies and changes and programs in health systems. “
2020 AHA presidential advisory calls structural racism “root cause of persistent health disparities in the United States”
Racism impacts the health of individuals and the population due to “racial and racialized residential segregation, mass incarceration, police violence and unequal medical care,” according to an article in The New England Journal of Medicine.
“We observed that counties with a high death trajectory had a higher proportion of black adults and worse measures of social distress, including higher vacancy rates and violent crime rates and low levels. high school, ”says Dr. Rao.
“It is not a coincidence. It is important to understand that structural and environmental characteristics are not randomly distributed. These patterns reflect historical patterns of structural racism, and much of what we’ve seen are the long-term downstream effects of those types of systems and policies that have created and maintained inequalities, whether openly stated. or not.
Medical News Today spoke with Dr Rocco Perla, co-founder of The Health Initiative. “This study reaffirms what physicians know: that access to health care intersects with access to the basics that people need to be healthy to produce health outcomes,” commented Dr Perla. “What is so striking about these results is that the counties with the highest risk of cardiovascular mortality are almost identical to counties with the highest rates of food insecurity.
“It is crucial that the next wave of healthcare reform directly address these basic drivers of health, especially as the economic consequences of COVID-19 only exacerbate healthcare outcomes and increase costs. He continues.
“It is for this reason that a recent Physicians Foundation survey found that 70% of physicians support insurance companies, including patients’ difficulties accessing nutritious food and safe housing in formulas. rating the risks that determine the complexity of patients.
It should be noted that the study has some limitations. For example, the authors find that using county data does not allow conclusions to be drawn at the individual level.
In addition, the study cannot establish causality between the risk factors and the health outcomes analyzed by the researchers.
Each year, racial inequalities cost the economy $ 93 billion in preventable health care costs and $ 42 billion in untapped productivity. However, the real cost is much higher, taking into account premature deaths and other economic losses.
As the country’s demographic diversity increases, addressing disparities is a crucial step towards improving the overall social and economic well-being of the country.
The UT research team maintains the importance of educating patients about controllable risk factors. Ultimately, however, they hope to enlighten decision-makers “on the need to address public health at community, state and national levels.”