Cardiovascular Disease in Racial and Ethnic Minorities (Contemporary Cardiology)

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Finally, the current literature consists of diverse disciplines e. Our systematic review adhered to PRISMA contemporary standards, [ 19 ] consolidating a considerable literature to examine links between commonly reported types of social discrimination and cardiovascular health indices. The comprehensive approach of this systematic review permitted the ability to identify key gaps and methodological limitations in the current literature which can inform future research studies on this topic.

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Although this review included prevalent types of stigmatized groups in American society, it was beyond the scope of this review to include all types of societal discrimination. More work is needed to examine cardiovascular health in the context of other types of discrimination, such as disability and religion.

Furthermore, there are some topic areas of this review that include few studies; therefore, larger conclusions cannot be made for these subcategories e. Also, this review only included articles published in English, and includes only studies conducted in the U. It is not known what differences may exist in the relationship between discrimination and cardiovascular health in different cultures where stigmatized groups e.

Cross-cultural research examining these issues will be informative in this regard. Finally, this review did not discuss the underlying mechanisms that may be responsible for the association between discrimination among stigmatized groups and adverse cardiovascular health. Although the mechanisms responsible for this association may be attributable to the way the body responds to the emotional distress of discrimination as a stressor, [ 11 ] more attention is needed to clarify underlying mechanisms that link these to increased CVD risk.

In light of the consistent evidence highlighting impaired cardiovascular health among stigmatized groups, it may be informative for health care providers to assess perceived discrimination in their patients when evaluating their cardiovascular health. If patients report experiences of discrimination due to their stigmatized identity, health care providers may want to consider further evaluating patients for indicators of adverse cardiovascular health.

In addition, implementing an interdisciplinary health care approach to patient care i. More broadly, raising awareness of the increased vulnerability for impaired cardiovascular health among stigmatized patient populations seems warranted. Health care providers may benefit from training on strategies to assess patients for experiences of discrimination, and to increase their awareness about the potential links between these experiences and cardiovascular health. Finally, some evidence has documented the potentially harmful role of stigma in the delivery of treatment and prevention of cardiovascular disease CVD for individuals who are vulnerable to stigma-based inequities.

Considerable evidence has additionally demonstrated that medical professionals hold negative stereotypes and biases towards patients with obesity [ , ]. In response to experiences of weight stigma in the health care setting, patients with obesity are less likely to undergo health screenings and more likely to delay or avoid seeking healthcare [ , ], increasing their likelihood of having undiagnosed and untreated CVD. Thus, health care providers may themselves benefit from education about discrimination and its impact on patient health, and from broader training efforts to help reduce stigma in the health care setting that could unintentionally perpetuate adverse experiences for patients who are vulnerable to stigma and its health consequences.

Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background There is a high prevalence of cardiovascular disease across diverse groups in the U. Results The search identified 84 eligible studies published between and Conclusions Future research should include longitudinal and randomized controlled trial designs, with larger and more diverse samples of individuals with stigmatized identities, using consistent measurement approaches to assess social discrimination and its relationship with cardiovascular health.

Funding: The authors received no specific funding for this work. Download: PPT. Table 1. Quality of studies All non-randomized studies were assessed for methodological quality and risk of bias using the Newcastle-Ottawa Scale NOS [ 22 ]. Data synthesis The current review was intentionally performed as a systematic review without meta-analysis due to the heterogeneity of the types of measures and samples included in this literature. Results Fig 1 describes the search and selection process which resulted in 1, identified records, yielding 84 eligible studies, published between and Fig 1.

Flow chart detailing the systematic search of potential reports and selection process of included studies n. Table 2. Table 3. Summary of study quality scores of the included cross-sectional and longitudinal cohort studies assessed by the Newcastle-Ottawa Scale NOS. Racial discrimination. Weight discrimination. Multiple types of discrimination. Sexual orientation discrimination. IV: Social discrimination and other cardiovascular health indicators Fifteen studies examined the relationship among other cardiovascular health indicators e.

Discussion This review aimed to provide an overview of the scientific evidence linking discrimination and cardiovascular health indicators among socially stigmatized groups. Table 4. Summary of evidence examining the links between discrimination and cardiovascular health among socially stigmatized groups. Strengths and limitations Our systematic review adhered to PRISMA contemporary standards, [ 19 ] consolidating a considerable literature to examine links between commonly reported types of social discrimination and cardiovascular health indices.

Implications for preventive health care In light of the consistent evidence highlighting impaired cardiovascular health among stigmatized groups, it may be informative for health care providers to assess perceived discrimination in their patients when evaluating their cardiovascular health. Supporting information. S1 File. S1 Table. All non-randomized studies were assessed for methodological quality and risk of bias using the Newcastle-Ottawa Scale NOS. S2 Table. S3 Table. References 1. Goffman E. Stigma: Notes on the management of spoiled identity: Simon and Schuster; Changes in perceived weight discrimination among Americans, — through — Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America.

Int J Obes. View Article Google Scholar 4. American Psychological Association. Stress in America: The Impact of Discrmination. View Article Google Scholar 5. Attitudes toward mental illness—35 states, District of Columbia, and Puerto Rico, World Health Organization. Stigma and Discrimination. View Article Google Scholar 7. Perceived discrimination and mortality in a population-based study of older adults. Am J Public Health. Perceived discrimination and health: a meta-analytic review.

Psychol Bull. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. Perceived racial discrimination and hypertension: a comprehensive systematic review. Health Psychol. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. The psychological weight of weight stigma. Social Psychological and Personality Science. View Article Google Scholar Cortisol and cardiac reactivity in the context of sex discrimination: The moderating effects of mood and perceived control.

The Open Psychology Journal. Associations between self-reported discrimination and diurnal cortisol rhythms among young adults: The moderating role of racial-ethnic minority status. Heart rate variability as a physiological moderator of the relationship between race-related stress and psychological distress in African Americans. Cultur Divers Ethnic Minor Psychol.

A preliminary experimental examination of worldview verification, perceived racism, and stress reactivity in African Americans. Racism and hypertension: a review of the empirical evidence and implications for clinical practice. Am J Hypertens. Systematic reviews.

Cohen J. Weighted kappa: Nominal scale agreement provision for scaled disagreement or partial credit. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Higgins J. Green S. Cochrane handbook for systematic reviews of interventions version 5. The Cochrane Collaboration. Racial discrimination associated with higher diastolic blood pressure in a sample of American Indian adults.

Am J Phys Anthropol. J Racial Ethn Health Disparities. Effect of perceived racial discrimination on self-care behaviors, glycemic control, and quality of life in adults with type 2 diabetes. Stress Health. Annals of Behavioral Medicine. Association between perceived racism and physiological stress indices in Native Hawaiians. Discrimination-related stress, blood pressure and epstein-barr virus antibodies among latin american immigrants in Oregon, us. J Biosoc Sci.

The effects of perceived discrimination on ambulatory blood pressure and affective responses to interpersonal stress modeled over 24 hours. Perceived discrimination, psychological distress and health. Sociol Health Illn. Perceived discrimination and blood pressure in older African American and white adults.

The inverse hazard law: blood pressure, sexual harassment, racial discrimination, workplace abuse and occupational exposures in US low-income black, white and Latino workers. Soc Sci Med. Cross-sectional association between perceived discrimination and hypertension in African-American men and women: the Pitt County Study. Am J Epidemiol. Salomon K, Jagusztyn NE. The Association between self-reported discrimination, physical health and blood pressure: findings from African Americans, Black immigrants, and Latino immigrants in New Hampshire. J Health Care Poor Underserved.

Perceived stress following race-based discrimination at work is associated with hypertension in African-Americans. The metro Atlanta heart disease study, — Effects of perceived racism and anger inhibition on ambulatory blood pressure in African Americans. Psychosom Med. Clark R. Perceptions of interethnic group racism predict increased vascular reactivity to a laboratory challenge in college women. Ann Behav Med. Krieger N, Sidney S. Implicit racial bias as a moderator of the association between racial discrimination and hypertension: a study of Midlife African American men.

Racial discrimination and the incidence of hypertension in US black women. Ann Epidemiol. PloS one. Perceived discrimination and health outcomes: A gender comparison among Asian-Americans nationwide. Womens Health Issues. Combining explicit and implicit measures of racial discrimination in health research. Racial discrimination and blood pressure: perceptions, emotions, and behaviors of black American adults. Issues Ment Health Nurs. Fla Public Health Rev. Psychosocial factors contribute to resting blood pressure in African Americans.

Ethn Dis. Peters RM. The relationship of racism, chronic stress emotions, and blood pressure. J Nurs Scholarsh. Stress-related racial discrimination and hypertension likelihood in a population-based sample of African Americans: the Metro Atlanta Heart Disease Study. Racism and hypertension among African Americans. West J Nurs Res. Relationship of internalized racism to abdominal obesity and blood pressure in Afro-Caribbean women. J Natl Med Assoc. John Henryism and blood pressure differences among black men. The role of occupational stressors. Clark R, Adams JH. Moderating effects of perceived racism on John Henryism and blood pressure reactivity in Black female college students.

The effects of racial stressors and hostility on cardiovascular reactivity in African American and Caucasian men. Health Psychology. Self-reported racism and social support predict blood pressure reactivity in Blacks. Discrimination and unfair treatment: relationship to cardiovascular reactivity among African American and European American women.

Perceived racism and cardiovascular reactivity and recovery to personally relevant stress. African Americans and high blood pressure: the role of stereotype threat. Psychol Sci. Effects of racist provocation and social support on cardiovascular reactivity in African American women. Int J Behav Med. Relationship of racial stressors to blood pressure responses and anger expression in black college students.

Chobanian A. National heart, lung, and blood institute; national high blood pressure education program coordinating committee. Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. J Am Soc Hypertens. REPRINT Treatment of hypertension in the prevention and management of ischemic heart disease: A scientific statement from the American Heart Association Council for high blood pressure research and the Councils on clinical cardiology and epidemiology and prevention.

J Am Coll Cardiol. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of randomised trials in the context of expectations from prospective epidemiological studies. Krieger N. Racial and gender discrimination: risk factors for high blood pressure? Examining the association between perceived discrimination and heart rate variability in African Americans. Heart rate variability standards.

Yasuma F, Hayano J. Respiratory sinus arrhythmia: why does the heartbeat synchronize with respiratory rhythm? Capturing the cardiac effects of racial discrimination: Do the effects "keep going"? Int J Psychophysiol. Differential heart rate responses to social and monetary reinforcement in women with obesity. Appetitive vs.

Autonomic measures and brain oscillation modulation. Brain Res. Racial discrimination predicts greater systemic inflammation in pregnant African American women. Appl Nurs Res. Self-reported experiences of everyday discrimination are associated with elevated C-reactive protein levels in older African-American adults.

Brain Behav Immun. When used as a risk marker, race suggests a collinear association with some other quantifiable variable, such as income or education. By contrast, when used as a risk factor, race implies shared genetic heritage and consequent susceptibility to specific diseases such as sickle cell anemia or cystic fibrosis Joseph et al. Understanding the root causes of health disparities requires surveillance at the population level for incidence and prevalence, predisposing factors, morbidity, mortality, and long-term outcomes.

Other important factors are linkage of such data to environmental, residential, geographic, socioeconomic, cultural, and educational domains. Prior surveillance data have shown that in comparison with white populations, racial and ethnic minorities generally have higher rates of CVD risk factors, CVD-related morbidity and mortality, poorer health, less adequate health care, and worse outcomes Roger et al.

Although the overall occurrence of COPD is higher among non-Hispanic white males compared with other racial and ethnic groups, in recent years the occurrence has been increasing more rapidly among African Americans compared to whites Brown et al. Moreover, relative disparities in mortality rates have increased from to for heart disease, from to for COPD, and from to for chronic lower respiratory disease Keppel et al.

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For COPD, limited evidence suggests that black men may be more susceptible to the adverse effects of cigarette smoke compared to white men Chatila et al. Overall mortality was lower among African Americans 7. Although crude mortality rates from COPD have been higher among African Americans compared with whites, there may be no difference in these deaths after adjustment for age, body mass index, smoking, alcohol use, diabetes, hypertension, education, and sports index Chamberlain et al.

Among the heterogeneous Hispanic population, limited data are available about chronic lung diseases Brehm et al. The influence of access to health care and quality of care among different racial and ethnic groups is discussed in greater detail in subsequent sections. Measurement and classification of populations and subpopulations by race and ethnicity for surveillance has become more challenging because of increased immigration from Central and South America as well as Asia and Africa.

Changes in the demographic characteristics of the U. The Pew Research Center reported that in , a record one in seven of all new U. The Pew Research Center has produced estimates of future changes in the proportions of racial and ethnic groups. According to those estimates, from to , the proportion of U. Growth in the proportion of foreign-born residents and their progeny in the United States has reinforced the importance of examining differences in the health and healthcare of immigrants, especially in regions, states, counties, or neighborhoods with significant proportions of immigrants.

Because of their long history of discrimination, residential segregation, unemployment, and poor SES, immigrant populations can have less favorable risk factor awareness, diagnosis, treatment, and control. Immigrants and migrants have had a tendency to move to and live in areas populated by people with similar backgrounds. Immigrants, particularly those who lack fluency in English, health literacy, and familiarity with the U.

Observed health disparities in specific racial and ethnic subgroups may result from shared social, economic, and physical environments as well as race or ethnicity. The relationship between acculturation and chronic disease indicators is complex and may have a significant effect on observed health disparities.

Acculturation or lack thereof may influence the health of socioeconomically and culturally homogeneous populations, whether native born or foreign born, residing in the same neighborhoods. The effects of acculturation may be subgroup specific, with differing impacts on the burden of disease, risk factors, markers of comorbidities, and outcomes. In a study of participants in the Multi-Ethnic Study of Atherosclerosis, a higher prevalence of carotid plaque a marker for carotid atherosclerosis was observed among whites, blacks, and Hispanics who had been in the United States for more generations, as well as in whites with less education and blacks with lower incomes Lutsey et al.

Among immigrants from diverse ethnic backgrounds, longer length of residence in the United States has been associated with increased odds of obesity, hyperlipidemia, and cigarette smoking, even after adjusting for relevant confounding factors. High levels of acculturation have also been associated with poorer risk factor control or a higher prevalence of chronic disease risk factors. Immigrants who speak their native language at home or have resided briefly in the United States may have reduced risk factor control.

Assessing Hispanic ethnicity and disease or risk factor surveillance is complex because of differing geographic origins and admixture of various subgroups in the United States. The ancestry of Hispanics depends on the country of origin, the region of the country in which they first settle, and the region in which they ultimately reside. For example, in New York large subpopulations of people of African origin could be classified into different categories, such as Barbadian, Haitian, Jamaican, Nigerian, Panamanian, Senegalese, Trinidadian, or from other locations in the African Diaspora.

Unhealthy living and working conditions and inadequate access to essential health services and other basic services e. Despite efforts to address health disparities by improving the quality of health care and health services delivered at the population, subpopulation, and individual levels, disparities in the major indicators of. These disparities persist in spite of the wide array of interventions available at the individual level, including improving primary and secondary prevention; increasing awareness, treatment, and control of predisposing factors; and increasing access to the latest diagnostic and therapeutic technologies.

This persistence of health disparities has focused attention on other possible determinants of health disparities, including geography, residence, and environment Do et al. Substantial evidence shows geographic variation in risk factors, prevalence and incidence, morbidity, and mortality for CHD and stroke. High heart disease mortality rates also have been observed in several U. The numerous hypotheses for the concentration of CVD and stroke mortality in the Southeast include geographic differences in the distribution of major cerebrovascular disease risk factors e.

However, even though many possible explanations for the Stroke Belt have been considered, the reasons for regional variation in stroke-related mortality have not been definitively established. A possible explanation for the observed concentration of stroke mortality in the southeastern United States is the higher prevalence of hypertension among Southern-born blacks than in blacks born elsewhere. Geographic heterogeneity of hypertension suggests that differences in the prevalence of hypertension between blacks and whites are not constant, but they may vary depending on which geographic groups are compared.

The presence of large variations in black—white differences suggests that race differences are not immutable i. Most of these factors are either modifiable or potentially amenable to interventions. Given these findings, public health interventions are essential for progress in reducing the stroke burden in the Stroke Belt region. Studies of increased stroke-related mortality in southeastern U. Less is known, however, regarding the importance of birth versus residence in the Stroke Belt in native- and foreign-born blacks and whites.

In a study of the association between birthplace and mortality from CVD among black and white residents of New York City, similar CVD death rates were observed for white and black men and white and black women born in the Northeast Fang et al. Black men born in the South had death rates 30 percent higher than northeastern-born blacks and four times that of Caribbean-born blacks of the same sex and age.

Cardiovascular Disease in Racial and Ethnic Minorities - Google книги

Higher rates of CVD mortality among blacks compared with whites may obscure substantial variation among blacks based on birthplace. Disparities may be influenced by the characteristics of the local community or neighborhoods, which may engender healthy or unhealthy behavioral practices. The perception of neighborhood safety is positively associated with physical exercise, and this association is larger for minority groups than for whites. Neighborhoods also differ in the existence and quality of recreational facilities and open, green spaces.

The availability and cost of healthful products in grocery stores also has been shown to vary across residential areas, and the availability of nutritious foods is positively associated with their consumption. In addition, it has been demonstrated that both the tobacco and alcohol industries heavily market their products to poor minority communities Williams and Jackson, Furthermore, they are more likely to have jobs in workplaces that expose them to dusts, gases, and fumes, which have been associated with an increased risk for COPD, which disproportionately affects African Americans and Hispanics Hnizdo et al.

Williams and Jackson observed the factors in Box in the social environment that can initiate and sustain disparities in health. Moreover, the differences in health by SES within each racial group are often larger than the overall racial differences in health. Income also plays a role in understanding racial differences in CHD coronary heart disease mortality. For example, death rates from heart disease are two to three times higher among low-income blacks and whites than among their middle-income peers.

In addition, for both males and females at every level of income, blacks have higher death rates from CHD than whites. Mortality from heart disease among low- and middle-income black women is 65 percent and 50 percent higher, respectively, than for comparable white women. Another pathway underlying the association between race and chronic diseases is the patterning of health practices by race and socioeconomic status.

Dietary behavior, physical activity, tobacco use, and alcohol abuse are important risk factors for chronic diseases including CHD, stroke, and chronic lung disease. Moreover, changes in these health practices over time are patterned by social status. Disadvantaged racial groups and those with low SES are less likely to reduce high-risk behavior or to initiate new health-enhancing practices.

Exposure to psychosocial stressors may be another pathway linking SES and race to the development of poor health and adverse outcomes once disease has been diagnosed.

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The subjective experience of discrimination is a neglected stressor that can adversely affect the health of African Americans. Reports of discrimination are positively related to SES among blacks and may contribute to the elevated risk of disease that is sometimes observed among middle-class blacks. The persistence of racial differences in health after individual differences in SES are accounted for may reflect the role that residential segregation and neighborhood quality can play in racial disparities in health.

Because of segregation, middle-class blacks live in poorer areas than whites of similar economic status, and poor whites live in much better neighborhoods than poor blacks. Residential segregation is a central mechanism by which racial economic inequality has been created and reinforced in the United States. It is a key determinant of observed racial differences in SES because it determines access to education and employment opportunities.

In addition, segregation creates health-damaging conditions in both the physical and social environments. Because of its restriction of educational and employment opportunities, residential segregation creates areas with high rates of concentrated poverty and small pools of employable and stably employed males. With recent recognition of worsening economic and social inequalities, more attention has been focused on the contribution of socioeconomic factors to health disparities.

Multiple socioeconomic factors contribute to health disparities, including income, education, residential segregation, stress, social and physical environment, employment, and many others. Disparities according to income and education have increased for smoking, with low-income persons smoking at higher rates. Diabetes prevalence has increased largely among persons from lower socioeconomic strata Kanjilal et al. Low educational attainment may also impact mortality rates.

However, the total number of deaths associated with low education status was not confined to any single racial or ethnic group. Low SES is associated with a higher prevalence of risk factors, greater chronic disease burden, and higher expenses for health care, medications, and hospitalization. The sick and poor are at risk of moving even farther down the socioeconomic ladder Fiscella and Williams, The reverse is also evident: those at the highest socioeconomic rank are likely to be more educated, have better risk factor profiles, improved health, and better health-related outcomes.

With greater access to information, more financial resources, greater access to high-quality health care, and the capacity and capability to benefit from advances in pharmaceuticals and healthcare technology, those who are more advantaged can move further up the socioeconomic ladder, while disadvantaged populations remain mired in unhealthy neighborhoods with the highest burden of CVD and COPD.

Improving the national surveillance of SES and its relationship to indicators of risk and health outcomes is a critical step toward reducing health disparities. Reducing the magnitude of clinically evident CVD and COPD in populations that bear a disproportionate burden of disease is an essential element in the struggle to eliminate health disparities. The principal goals of primary prevention include risk assessment; reduction of risk by control of key pre-disposing factors, including cigarette smoking, elevated cholesterol, elevated blood pressure, obesity, and diabetes; and limitation of progression of subclinical disease.

The prevalence of hypertension in U. As in other subclinical CVD conditions, primary prevention for individuals with pre-hypertension is recommended through vigorous lifestyle and diet modification, and may also include affordable pharmacologic therapy if shown to improve health outcomes Greenlund et al. Successful therapeutic interventions in patients with CVD—particularly myocardial infarction and stroke—have expanded the population of U.

Interventions for secondary prevention include lifestyle modifications and pharmacologic treatments to control smoking, hypertension, hyperlipidemia, and diabetes, as well as coronary revascularization procedures that can relieve symptoms and, in some cases, extend survival. The growing number of older adults with CVD and COPD requires specific surveillance of health disparities, with special attention to monitoring adherence to healthy lifestyle practices and effective treatment regimens and the effect of different treatment approaches on quality of life, recurrence, and long-term prognosis.

Standardized surveillance approaches for monitoring the effectiveness of secondary prevention are needed Willson et al. Racial and ethnic differences in the receipt of catheterization and coronary revascularization were reported in early studies Gillum et al. Brown and colleagues analyzed the receipt of cardiac catheterization, PCI, and CABG by age, sex, insurance status, and race among black and white patients discharged from U.

They found that consistent and significant disparities in the receipt of cardiac catheterization, PCI, and CABG by age, sex, insurance status, and race persisted across the 25 years of study; however, attenuation of these differences were observed from to for each subgroup examined. Specifically, although blacks were 27 percent less likely to receive diagnostic cardiac catheterization in , they were only 11 percent less likely to undergo cardiac catheterization in Brown et al.

Racial disparities in the use of drug-eluting stents have also been reported Gaglia et al. A number of investigations have been conducted in different patient populations to explore potential racial differences in healthcare use and quality of care for persons with COPD. In a Medicaid population of 9, patients with COPD and asthma, African Americans had lower overall healthcare use and costs when compared to whites, including physician office visits and outpatient and inpatient services Shaya et al. Gordon and coworkers examined the quality of processes of care for CHF and COPD at Veterans Administration hospitals and found no difference in the quality of care provided to blacks and whites.

Tsai and colleagues examined racial and ethnic differences in processes and outcomes of emergency room care among a cohort of patients with COPD enrolled from 24 emergency departments from 15 states. Compared to whites, African American and Hispanic patients had lower SES and primary care access and more frequent exacerbations, but there were no statistically significant differences in the processes or outcomes of care.

Hasnain-Wynia and coworkers found that a higher proportion of racial and ethnic minorities were cared for at lower performing hospitals. Among patients with severe COPD waiting for lung transplantation, African American patients were less likely to have a transplant and more likely to die Lederer et al. Rates and trends of risk-adjusted hospitalization rates for specific conditions provide population-level evidence on the adequacy of access to primary care, known as ambulatory care sensitive conditions ACSCs , and effectiveness of various interventions AHRQ, Variations in risk-adjusted hospitalization rates for ACSCs have been examined to determine racial, ethnic, socioeconomic, and geographic disparities for these conditions Bindman et al.

A nationwide sample of community hospital discharge data demonstrated that compared to non-Hispanic whites, African American men adjusted relative rates of 1. On the other hand, an analysis of admission rates in North Carolina among Medicare beneficiaries for ambulatory sensitive conditions, including COPD, found that African Americans had lower admission rates for COPD compared to whites odds ratio 0. The highest rates of hospitalization have been found among rural counties, the elderly, non-Hispanic whites, and women in urban areas Jackson et al. African Americans had lower hospitalization rates compared to non-Hispanic whites, and Hispanics had the lowest rates.

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  8. Untangling the effects of environment, income, education, race, ethnicity, and genetics may lead to the more precise targeting of preventive, diagnostic, and therapeutic interventions. This in turn will contribute to the elimination of health disparities, reduction in the magnitude of chronic disease, and improvements in prognosis and quality of life in those with established disease. However, there is a lack of standardization in the collection of race, ethnicity, and language data at the federal, state, and local levels.

    This lack of standardization creates difficulty in identifying disparities and appropriately targeting quality improvement efforts. However, gaps in the collection of disparity data are evident at various levels.

    The principal challenge is to develop systems that more effectively and efficiently link conventional surveillance data to more contextually relevant data e. A wide array of factors may interact to determine population health, including biological or genetic factors, health behaviors and lifestyle practices, socioeconomic status, the environment, access to health services, and cultural or linguistic isolation.

    Appreciation of the heterogeneity of the general population and the many health-related factors that distinguish populations, subpopulations, and groups within subpopulations from each other has grown over time and in importance. Therefore, a critical need remains for standard definitions of CVD and COPD data elements, as well as a need for consensus regarding the operationalization of race and ethnicity, SES, and biological risk factors in the surveillance of CVD and chronic lung disease. Impressive gains have been achieved in life expectancy for the overall American population, as well as distinct subpopulations defined by race and ethnicity.

    However, inequities in health status and health systems remain in many neighborhoods, cities, states, and regions. A contemporary and ongoing national framework for the surveillance of CVD and COPD disparities will facilitate the development of actionable policies and programs informed by data gathered at the national, regional, state, and community levels. This aggregation and reporting can provide information about where persistent disparities in health and health care exist. These data will help providers understand the populations they serve, address disparities, and improve and monitor healthcare quality.

    A lack of valid race and ethnicity data creates difficulty in identifying disparities and appropriately targeting strategies to address them. This framework will support efforts to advance the prevention and effective treatment of chronic disease to ensure the highest quality health care for the U. The committee concluded that the national framework for surveillance would be enhanced by the recommendations of the Institute of Medicine, Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement Therefore the committee supports these recommendations.

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    Cardiovascular Disease in Racial and Ethnic Minorities (Contemporary Cardiology) Cardiovascular Disease in Racial and Ethnic Minorities (Contemporary Cardiology)
    Cardiovascular Disease in Racial and Ethnic Minorities (Contemporary Cardiology) Cardiovascular Disease in Racial and Ethnic Minorities (Contemporary Cardiology)
    Cardiovascular Disease in Racial and Ethnic Minorities (Contemporary Cardiology) Cardiovascular Disease in Racial and Ethnic Minorities (Contemporary Cardiology)
    Cardiovascular Disease in Racial and Ethnic Minorities (Contemporary Cardiology) Cardiovascular Disease in Racial and Ethnic Minorities (Contemporary Cardiology)
    Cardiovascular Disease in Racial and Ethnic Minorities (Contemporary Cardiology) Cardiovascular Disease in Racial and Ethnic Minorities (Contemporary Cardiology)

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