‘Structural racism’ reflected on regional cardiovascular death rates

The U.S. offers experienced a reduction in CVD-related death rates over the past 40 years. However, scientists from the University of Texas (UT) Southwestern INFIRMARY in Dallas have learned glaring disparities between areas with huge and low mortalities.

The team presented their research at the American Heart Association’s (AHA) Epidemiology, Avoidance, Lifestyle & Cardiometabolic Overall health conference on May 20, 2021.

The researchers reviewed info gathered between 1980 and 2014 from all 3,133 U.S. counties. CVD-related deaths included all deaths attributed to cardiovascular triggers on the death certificates.

They targeted county-level data because that is where many decision-makers devise general public health policies.

Using a ClustMixType algorithm approach yielded 3 distinct clusters of counties predicated on the CVD-mortality trajectories more than the study’s timeline.

“Large mortality” counties had a baseline of around 60 CVD deaths per 10,000 population. “Intermediate mortality” and “low mortality” clusters experienced a baseline of 50 and 40 CVD deaths per 10,000 population, respectively.

The researchers compared these statistics with county-level demographic, environmental, and health markers. These data included crime rates, casing vacancies, smoking, diabetes, weight problems, and food scarcity.

The analysis revealed parallel declines in CVD deaths among all groups.

On the other hand, Dr. Shreya Rao, the study’s lead writer and research fellow at the UT Southwestern Medical Center in Dallas, recounted:

“We were surprised to find that even though CVD death rates increased across the country, including in areas where costs had been among the highest and the cheapest, relative differences across county groups and existing disparities among counties didn't change. Counties that began with the best rates of loss of life continued to execute worse than other counties, and the ones with the lowest rates of loss of life stayed the lowest through the study period.”

Regions of great concern

The regions with the cheapest CVD mortality included counties in the Northwest, Great Plains, Midwest, Northeast, and Florida.

Areas found in the South Atlantic claims, Deep South, and portions of Appalachia found the highest mortality rates.

Dr. Rao notes: “High-mortality counties were a lot more clustered and centered in areas known to have high costs of chronic health conditions, such as cardiovascular disease, stroke, high blood pressure, type 2 diabetes, and obesity.”

The study discovered that the highest-mortality counties had higher nonwhite populations. These areas likewise saw low high school completion rates, bigger violent crime, and bigger housing vacancies.

It figured education position, violent crime costs, and cigarette smoking were the strongest predictors of being in the high-mortality subgroup.

The UT researchers remember that public health agencies usually do not normally consider social issues as controllable risk factors for CVD. However, the study’s authors believe these problems impression long-term health outcomes.