Physical, Social Environments Impact Racial Disparities in Cardiovascular Health

The racial differences in cardiovascular health are impacted by the varying experiences within physical and social environments and by an individual’s lived experiences, especially discrimination, according to the results of a study published by JAMA Network Open. The study authors emphasized the importance of targeting neighborhood factors and discrimination in approaches to improve the ideal cardiovascular health.

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According to the authors, Black individuals in the United States typically have earlier onset cardiovascular disease (CVD) risk factors and poorer overall cardiovascular health compared to White individuals. The study authors noted that the increased risk of CVD is associated to psychosocial stress and coping mechanisms, which they feel might contribute to the health disparities. Investigators aimed to determine whether the racial differences in cardiovascular health could be associated with the experiences by neighborhood- and individual-level stressors.

Data from 7720 individuals were examined from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based analysis of 30,329 non-Hispanic Black and non-Hispanic White individuals aged 45 years or older at baseline. The demographics of the individuals had a mean of 71.9 years, 56.9% were women, 26.9% were Black, and 73.1% were White. The individuals completed a second in-home visit from 2013 to 2016. The data for this study were analyzed from June 2021 to July 2021 and in March 2022, according to the study authors.

Investigators used data on neighborhood physical environments, including excessive noise and violence, scored from 7 to 28 with a higher score indicating more issues; neighborhood safety, scored as very safe, safe, or not safe; neighborhood social cohesion, including shared values, scores from 5 to 25 with a higher score indicating more cohesion; perceived stress, including coping, scored from 0 to 16 with a higher number equaling more stress; and the experience of discrimination.

Furthermore, they measured ideal cardiovascular health by using a composite of 4 health behaviors, including cigarette smoking, diet, physical activity, and body mass index, and 3 health measures, including blood pressure, cholesterol, and glucose levels.

In the study, Black individuals reported higher perceived stress at a mean score of 3.2 and more discrimination at 77% compared to White individuals at 2.8 and 24%, respectively. Further, Black individuals also reported poorer neighborhood environment at a mean score of 11.2 compared to 9.8, social cohesion at 15.5 compared to 15.7, and more unsafe neighborhoods at 54.7% and 24.3%, respectively.

Additionally, they found that Black individuals who had closer to ideal cardiovascular health scores were lower compared to White individuals, both overall and when adjusted for gender. Black men had a 27% lower odds of an ideal cardiovascular health score compared to White men and Black women had 55% lower odds compared to White women.

In a mediation analyses, the racial disparity in ideal cardiovascular health scores was reduced by physical environments at 5.14%, neighborhood safety at 6.27%, neighborhood social cohesion at 1.41%, and discrimination at 11.01%, according to the study authors. The factors that attributed the most to the reduction were neighborhood safety for men and discrimination for women. The investigators also noted that perceived stress did not impact the racial disparity in total ideal cardiovascular health scores.

The study authors concluded that approaches to improve these scores should be targeted at neighborhoods and discrimination by gender and race.

References

Hines AL, Albert MA, Blair JP, et al. Neighborhood factors, individual stressors, and cardiovascular health among black and white adults in the US: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. JAMA Netw Open. 2023;6(9):e2336207. doi:10.1001/jamanetworkopen.2023.36207