older man at doctor

Black adults under age 65 have more than twice the risk of dying from cardiovascular disease as white adults under 65, according to a new study led by Gabriel Tajeu, assistant professor of health services administration and policy.  In a study published in the May 2020 issue of the American Journal of Public Health, Tajeu and the research team found that socioeconomic status and cardiovascular disease risk-factor differences between black and white adults are the overwhelming factors accounting for the disparity.

"We know that race is associated with an increased risk of cardiovascular disease, but very little of the difference in health outcomes between white and black adults can be attributed to genetic factors," says Tajeu.  Race, he writes, citing Harvard sociologist David Williams, is a social construct more than a biological category.

He worked with co-authors from Weill Cornell Medical College and the University of Alabama at Birmingham, whose multiyear Reasons for Geographic and Racial Differences in Strokes (REGARDS) study provided the core data for the research. That study, which was national but focused on stroke incidence in the Southeastern US, collected information from more than 30,000 participants on health factors including cholesterol, body-mass index, diabetes, cigarette smoking, depression, stress, and medication use as well as demographics such as race, sex, education, income, and health insurance status.

"We compared blacks and whites who live in the same geographical region—not necessarily in the same circumstances—who are the same sex and same age. And that's when we observed that the risk of CVD mortality was over twice as much for blacks, compared to whites, who are younger than 65," Tajeu says.

When the authors compared black and white participants with similar socioeconomic status and health risk factors, the disparity in CVD mortality almost disappeared.  Data analysis revealed the disparity was largely due to differing socioeconomic status of black and white participants.

According to Tajeu, the findings build on a model from Harvard sociologist David Williams, who suggested that historical, political and legal structures in the United States have led to racial differences in socio-economic status.

"In the Williams model, lower socio-economic status leads to things like limited health insurance and disruption of the nuclear family. Those lead to underlying clinical risk factors like hypertension, which lead ultimately to disparities in health outcomes like heart attacks and strokes," Tajeu explains. "The findings of our study provide more evidence of the power of the Williams model to conceptualize health disparities."

The study's findings also point to immediate and longer-term needs, Tajeu concludes.

"In the short and medium term, preventing the development of cardiovascular disease risk factors equitably is necessary,” he says. “We need to make sure there are targeted interventions for cardiovascular disease risks factors, focusing on prevention and treatment.  Longer term, in the ideal scenario, the social determinants of health would be the same between blacks and whites. That's what we should strive for.  It's the most critical long-term intervention that federal policymakers can engage in."