Analyzing Racial Cardiology Disparities in Healthcare

Equality doesn’t always mean equity. Take for example a group of kids watching a baseball game from behind a tall fence. There are two crates on the ground and two children watching the game. Each child can stand on the crate to better view the game. That’s equality, everyone is there, and everyone gets a crate to stand on. But what happens when the children are very different heights? The tallest child can see over the fence without a crate while the shortest child can’t see over the fence even while standing on a crate. One solution would be to stack both crates so the shortest child can see without taking anything away from the viewing experience of the taller child – that’s equity.

In 2000, the National Institute of Health defined disparity as a particular type of health difference that is closely linked with social, economic and environmental disadvantage. Health disparities adversely affect groups of people who have systemically experienced greater obstacles to health and have historically been linked to discrimination in healthcare. Those who experience health disparities are often further affected by upstream determinants such as poverty, racism and discrimination; and midstream determinants like social determinants of health (SDOH), food insecurity, the digital divide and anything shaped by – or a lack of- resources.

Take, for example, cardiac care. Peripheral Arterial Disease (PAD) presents as an obstructive disease of the lower extremities with significant morbidity and mortality. The causes are complex and include modifiable risk factors, like uncontrolled diabetes, genetics, and environmental exposures.

Black people are diagnosed with PAD 2.5 times more often than other races. They have the highest incidence rates, worse symptoms, higher amputation, and higher mortality rates than any other race. Yet Black patients are among the lowest group being treated for PAD.

Diabetes is a primary driver of PAD. Preventing or controlling diabetes requires access to healthy foods, safe places to exercise and affordable medications. For life-saving clinical trials, Blacks were significantly underrepresented in lipid-lowering studies, representing only 1 percent of 30,000 patients participating in trials despite the disparities in disease diagnosis.

Heart failure will affect over eight million people by 2023 and costs roughly $70 billion annually to treat. The onset of heart failure at a younger age is most prevalent in Blacks and Hispanics. When looking at clinical trials for treating heart failure, the most vulnerable populations were the least enrolled.

In cases of Atrial Fibrillation, where oral anticoagulant (OAC) is used in treatments, Blacks were significantly less likely to receive OAC and Direct OAC and were often found to be inappropriately dosed when they did receive these therapies. Further, when rhythm control strategies such as catheter ablation therapy and medication control were used to increase the chance of survival when treating Atrial Fibrillation, Blacks and Hispanics were less likely to receive these therapies than their white counterparts. In a recent study for catheter ablation comprised of 1280 patients, racial minorities accounted for less than 10 percent of study participants.

Addressing healthcare disparities is more cost-effective than treating advanced healthcare problems down the line. Studies that specifically address the reasons behind health disparities and those that offer effective and implementable solutions are critical to closing the gaps in health care while reducing costs and morbidity rates.

Who is policing quality? Why does this disparity exist? What is the call to action to get these numbers corrected? Questions such as these are necessary in order to advance initiatives and present solutions to these issues. But more investigators are needed to figure out the why. It begins with policy and government action to provide the recourse that is needed to understand these healthcare disparities.

The gap of disparities in healthcare will continue to widen and morbidity rates will continue to increase until action is taken. For now, what we have to best serve our patients is the call to action of one-person armies.

This information was presented at the ACOFP 60th Annual Convention and Scientific Seminars. We are pleased to offer more than 40 hours of AOA Category 1-A CME and (new this year!) AMA PRA Category 1 Credit(s)™ to watch on-demand from the convenience of your home or office! Learn more: https://www.acofp.org/acofp23