ISLAMABAD, April 01 (Online): An estimated 60 millionTrusted Source women in the US (equal to 44% of the population) live with some form of cardiovascular disease (CVD).
Additionally, 1 in 5 deaths among women stems from CVD — with those from racial and ethnic minorities at greater riskTrusted Source.
‘Traditional’ contributing factors, such as obesity, smoking, diabetes, and high cholesterol, is frequently considered by doctors when assessing a patient’s CVD risk.
However, a new scientific statementTrusted Source from the American Heart Association (AHA), published in its journal Circulation, highlighted that medical professionals must look beyond these when monitoring and treating CVD in women, especially those from underrepresented groups.
“In comparison to other women, Black women in the US (including African American and Afro Caribbean) have the highest rate of heart disease,” stated Dr. Heather M. Johnson,a preventive cardiologist at Boca Raton Regional Hospital, part of Baptist Health South Florida, who was not involved with the report.
The AHA researchers stated that “nontraditional”socio-economic factors — such as discrimination and environment — must be considered if the gap in CVD treatment and survival between whites and racial and ethnic groups is to be reduced.
Many of these are often overlooked but can significantly affect health risks, care, and outcomes.
“Understanding both traditional and nontraditional risk factors are important to prevent heart disease, but also to support the early diagnosis and treatment of heart disease in women,” Johnson told Healthline.
How bias, discrimination, and racism can affect your health
In the statement, the researchers said: “Behavioral and environmental factors and social determinants of health … disproportionately affect women of underrepresented races and ethnicities.”
“These factors result in a higher prevalence of CVD and significant challenges in the diagnosis and treatment of cardiovascular conditions,” they added.
Five social determinants of health were emphasized in the AHA’s statement. But what are they and how do they influence CVD?
Discrimination
The AHA noted that discriminatory barriers faced by ethnic communities lead to high levels of stress. This, in turn, contributes to CVD issues such as inflammation and hypertension.
ResearchTrusted Source also highlights that minority groups can encounter racial bias and stereotyping from white healthcare providers — which may lead to patients having their concerns dismissed or receiving poorer care.
“Studies show this is often due to the activation of stereotypes that influence clinical judgment,” said Heather Orom, PhD, associate professor of community health and health behavior at the University at Buffalo.
Furthermore, when actions are perceived as racially motivated or discriminatory, this can “put a wedge between provider and patient and create an environment of mistrust,” said Dr. Deborah L. Crabbe, a professor of medicine at the Temple Heart and Vascular Institute at Lewis Katz School of Medicine.
As a result, she told Healthline, “patients may not follow through with care recommendations and may even seek other providers, perhaps delaying care for their medical condition.”
Language barriers
Understanding medical terms and phrasing can be tricky enough for patients at the best of times. However, things are complicated further when the doctor and patient don’t share the same first language.
“Language barriers can reduce patients’ satisfaction with their care, care quality, and safety,” explained Orom.
Furthermore, she told Healthline, such barriers can hinder the doctor-patient relationship, prevent patients from advocating for themselves, and inhibit the doctor from understanding the full complexity of a patient’s condition and their life circumstances.
Environment
The AHA statement revealed that “environmental factors, such as air pollution, high long-term arsenic exposure, and cadmium and lead exposure, have been linked to CVD.”
Studies show minority groups are more likely to live in areas with more air pollutionTrusted Source and closer proximity to toxic waste and other hazards.
“For decades, polluting industries, waste facilities, and other sources of exposure, such as highways systems, have been more likely to be placed in neighborhoods of color,” Orom revealed. “This stems from the fact these communities have had less political and economic clout.”
Assimilation to a different culture
The AHA statement didn’t expressly state how acculturation or assimilation to a different culture can impact CVD.
However, “this is an important factor for CVD that often is missed,” stated Dr. Yu-Ming Ni, a cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center.
For instance, he shared with Healthline that older studiesTrusted Source of Japanese individuals showed those who traveled to Hawaii and then to the continental U.S. had higher CVD rates than their peers who stayed in Japan.
Healthcare access
It was noted in the AHA statement that “there is evidence that SDOH factors experienced in youth, such as … inability to access healthcare or inability to afford care, may affect heart health into adulthood and contribute to CVD risk factors and outcomes in adulthood.”
Research shows that Black, Hispanic, Asian-American, and Native individuals are less likely to have health insurance.
But healthcare access isn’t only about insurance, said Crabbe. For example, “[it also] includes geographic access to a particular health care service.”
Orom concurred, stating there is a typically “lack of high-quality healthcare facilities in neighborhoods where people of color have historically lived.”
Other social burdens can limit access, too. For example, United States Census Bureau data shows that ethnic minority groups are generally poorer compared to white populations. Poverty can prevent individuals from purchasing necessary medications, for example.
Finally, Michele Horan, a registered nurse and COO of Healthy Alliance, shared that other daily stressors — such as care responsibilities and the potential of eviction — can reduce the capacity of underserved communities to access healthcare.
“In most cases, these urgent situations are prioritized over one’s health and well-being,” Horan told Healthline. “Addressing life challenges, in my experience, will almost always surpass healthcare, accessible or not.”
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