Heart Disease in Underserved Communities

The prevailing image of heart disease is often an older white male—but it’s not an accurate picture

As part of National Heart Month, you’ve likely seen popular US statistics that are published each February:

• It’s the leading cause of death for men and women
• 1 in 4 deaths is related to heart disease each year
• Someone has a heart attack every 40 seconds—and 1 in 5 is “silent,” meaning the sufferer is not aware of it

While these facts are sobering enough, they fail to tell the story of the disproportionate impact that heart disease has on many black, Hispanic, and American Indian communities. And further, why affordable access to meaningful care is vital to reducing that impact.

Heart disease, race, and gender

The Department of Health and Human Services reports that, in 2018, African Americans were 30 percent more likely to die from heart disease than non-Hispanic whites. Also consider that, while African American adults are 40 percent more likely to have high blood pressure—a risk factor of heart disease—they are less likely to have it under control, due to limited access to care. Both black and Hispanic adults are more likely to have diabetes than white adults—another risk factor and comorbidity for heart disease.

Data from 2018 found that American Indians/Alaska natives were 50 percent more likely to be diagnosed with heart disease than their white counterparts.  They’re also more likely to be obese, to have high blood pressure, and to be current smokers—all factors that result from under-resourced and underserved communities that face serious cardiovascular issues.

Women of color see similar disparity—African American women are nearly 60 percent more likely to have high blood pressure and 50 percent more likely to be obese due to a lack of meaningful care access, as compared to non-Hispanic white women. In fact, research from the Office of Women’s Health found that women of any race do worse than men after a heart attack; those between 45 and 65 are more likely to die within a year of a heart attack than men in the same age range.

The chance of survival for other groups is equally poor. The American Heart Association reports that blacks are nearly twice as likely to have a first stroke and much more likely to die from one than whites. American Indians/Alaska Natives die from heart disease much earlier than expected—36% are under 65 with only 17% for the general US population.

The reality of these findings? Heart disease is not simply the number one killer of men and women in the US, but a disease that disproportionately affects the same underserved groups that don’t see equitable levels of care compared to white populations.

The Social Determinants of Health—and why they matter

Research from the Minority Health Summit and the Cardiovascular State of the Union found a major contributor to heart disease’s impact across societal lines: historically marginalized populations confront more barriers to heart disease diagnosis and care, receive lower quality treatment, and experience worse health outcomes than groups that have faced no such marginalization.

A survey from the American Heart Association found that Hispanics and blacks are less likely than whites to have access to a regular source of medical care. Another report found that cardiac care quality of racial and ethnic minority groups found evidence of disparities in 84% of the studies examined. Further evidence suggests that black adults more far more likely than white adults to be admitted to the hospital for angina and congestive heart failure—serious conditions that were likely missed or neglected due to systemic barriers.

These outcomes are linked to what is known as the Social Determinants of Health (SDoH)—an intersection of complex factors including income, education, access to care, and communication barriers that affect health.

In short, it’s often not your genetic code or family tree that should concern you, but where your live, your financial security, and even your level of education that most affects your health. And systemic inequities mean that most (and in many cases, all) of these factors are beyond the control of marginalized groups without focused intervention.

What does this mean? For millions of Americans, the societal and historic barriers that prevent them from affording (or even accessing) meaningful care is often the difference between a clean bill of health and a premature death from preventable heart disease.

Breaking down barriers and reestablishing care

To solve the imbalanced impact of heart disease in disadvantaged communities, access to care must be the first step—a solution many national and international leaders in healthcare are pushing. There are promising initiatives already at work:

• In 2020, the American Medical Association and a coalition of heart health experts announced a campaign with ESSENCE aimed at partnering and encouraging black women to achieve healthy blood pressure as part of improving heart health
• The Association of Black Cardiologists (ABC) is a national advocacy group that addresses fair and equal patient care, professional medical opportunities for African Americans, and federal policymakers on regulations and laws that support health equity
• The American College of Cardiology continues research into the present inequities across, race, ethnicity, and sex as it relates to heart health—and the societal factors that contribute

Advanced primary care providers like Marathon Health are taking on the issue of access by partnering directly with employers to provide affordable care to communities that otherwise struggle with consistent access. Onsite and worksite health centers serve as no- and low-cost touchpoints for patients who either can’t reach or afford traditional models or who have been neglected by fee-for-service care that prioritizes patient volume.

Patient-centered models that encourages just-right appointment times and a trusted provider relationship allow individuals who have felt unseen and unheard—especially those already facing systemic and racially-motivated barriers—are given the chance to self-advocate and share goals with the provider they’re seeing.

The role of trust in health outcomes

While not directly related to heart health, the COVID-19 pandemic has underscored the impact that trust plays in mitigating health risks. A recent study found 70% of black survey respondents felt that the pandemic response is biased against certain demographics. And only 18% said that they trust the federal government to look out for their best interests. Compare these findings with the fact that 28% of black Americans said they know someone who has died from COVID-19, while only 11% of white Americans reported the same.

Like the COVID-19 pandemic, the current threat of heart disease against minority communities is only hurt by the lack of trust that many Americans feel toward healthcare providers and the system they represent. It’s why time spent with a provider—a seemingly minor difference between traditional fee-for-service models and patient-centered value-based care—can mean the difference between a troubling diagnosis and that diagnosis avoided thanks to consistent access.

Services like Community Care Connect, as well, bridge the gap between awareness of community offerings and the action to use them. This platform highlights local services like food pantries, financial assistance, mental health support, housing, and more at no or reduced cost to under-resourced people. Marathon Health also pairs primary care with onsite and virtual mental health care that draws attention to the relationship between mental health—another serious condition that disproportionately affects marginalized groups—and cardiovascular issues.

While the historic impact of heart disease on people from minority communities is grievous, its future impact can be mitigated through strong inroads of access, affordability, and trust within the healthcare setting. During the close of February’s National Heart Month, consider revisiting the “image” of heart disease and its disproportionate impact on those who need—and deserve—care the most.