Social Determinants of Health? What it Means for Heart Disease in Black Americans

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Because education level, address, income and other factors contribute to the prevalence of high blood pressure and cardiovascular disease in Black Americans, a key step to helping patients is to ask about them during clinical assessments.

According to research published in the Journal of the American College of Cardiology, these factors, called social determinants of health, are part of culturally-tailored approaches to medicine that could address statistics that show Black Americans are more likely to develop and die from heart disease. This contributes to a life expectancy of 72, compared to 77 in white Americans.

Dr. Njeri Thande of the Hartford HealthCare Heart & Vascular Institute emphasized the many socioeconomic factors that contribute to the disparity in cardiovascular disease mortality.

“For example, poor diet quality, which might be influenced by culture, finances and neighborhood,” she said. “Is there an easily accessible market with affordable fruits and vegetables? Is the doctor’s nutrition advice culturally tailored?”

Other factors, she said, include:

  • Lack of physical activity influenced by neighborhoods that might be unsafe or lack sidewalks, and the high cost of gym memberships.
  • Stress stemming from job insecurity, housing instability and racial discrimination.
  • Lack of access to quality healthcare, influenced by the inability to miss work to go to a doctor’s appointment, lack of transportation or high parking fees at some healthcare facilities.
  • “Ingrained fears” about the healthcare system because of historic abuse that make it less likely for Black Americans to trust and follow physician recommendations.

The result is an increase in and poorer control of dangerous conditions as high blood pressure which can lead to stroke and kidney disease, which are also prevalent conditions among Black Americans.

Dr. Thande stressed the potential role of physician inertia or inappropriate treatment regimens. Some physicians, she explained, are not aware that certain blood pressure medications tend to be more effective than others in Black Americans.

As a Black cardiologist, Dr. Thande said she routinely emphasizes preventive measures within their control to family, friends and patients to help them avoid cardiovascular disease.

That includes:

  • Moving more.
  • Finding ways to relieve stress and improve overall mood.
  • Making better food choices, starting with small changes that are easier to adopt and repeat.
  • Visiting the doctor regularly and getting health screenings on schedule.

“It’s important to find a doctor you can trust, which might mean seeking out a Black doctor or someone from a similar ethnic background or cultural heritage. I recommend shopping around to find a doctor who listens, takes time and has empathy. Trusting your doctor is absolutely essential to improving your health,” she said.




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