1. Health Disparities in Cardiovascular Disease Paula A. Johnson, MD, MPH Chief, Division of Women’s Health; Executive Director, Connors Center for Women’s Health & Gender Biology, Brigham and Women’s Hospital Brigham and Women’s Hospital

2. Source: AHA, Heart Facts 2004: African Americans

3. Why Cardiovascular Disease? By preventing CVD among African Americans and decreasing disparities, we address: – Access to care/equality – Biologic differences – Environmental issues Stress Racism Environmental/contextual challenges to healthy behaviors – Prevention of other chronic diseases

4. Cardiovascular Disease (CVD) in Massachusetts and the United States CVD, primarily coronary heart disease and stroke, is the leading cause of death for MA blacks and whites, accounting for over 15,000 or about 27% of MA deaths in 2001 In 2001, rates CVD deaths in MA were 18% higher for blacks than whites Black women tend to develop heart disease at an earlier age and have the highest mortality rate from heart disease of all women The National Heart Lung and Blood Institute estimates that cardiovascular disease will cost the U.S. $368.4 billion in 2004 in direct and indirect costs Sources: MDPH, CDC

5. Source: MDPH, 2001 Mortality Records

6. Source: MDPH, Massachusetts Deaths, 2001

7. Source: CDC/NCHS Health, United States, 2003

8. Stroke Stroke is the third leading cause of death in MA, accounting for 3,534 deaths or about 6% of all deaths in 2001 In 2001, MA blacks were 33% more likely to die of stroke than whites; most of this difference is accounted for by disparities among women, with black women 37% more likely to die from stroke than white women Source: MDPH, MA Deaths, 2001

9. Source: MDPH, Massachusetts Deaths, 2001

11. Risk Factors Approximately 80% of cardiovascular disease is preventable. Risk factors for CVD include: – Overweight and obesity – Physical inactivity – Diabetes – Cigarette smoking – High blood pressure – High blood cholesterol – Family History – Age

12. Overweight and obesity Black adults are more likely than all other race/ethnicity groups to be overweight Significant disparities exist among women; in 2000, black women were 56% more likely to report being obese or overweight than white women in Massachusetts Factors that are particularly important include physical activity and a healthy diet The relationship between stress and obesity is being explored and may have particular relevance for the black community Sources: US DHHS, MDPH BRFSS 2000

13. OverweightObesity Source: MDPH, BRFSS, A Profile of Health Among Massachusetts Adults, 2002

15. Physical Inactivity Physical inactivity is more prevalent among African-Americans than whites In Massachusetts in 2002, blacks were 21% less likely than whites to report physical activity in the previous month

16. Source: MDPH, BRFSS, A Profile of Health Among Massachusetts Adults, 2002

17. Diabetes Adults with diabetes are 2-4 times as likely to die of heart disease than those without diabetes In 2001, Massachusetts blacks were 3.2 times more likely to be discharged from a hospital with a diagnosis of diabetes than whites The prevalence of diabetes among blacks in the U.S. has quadrupled during the past 30 years, with increasing incidence in black youths Approximately 2.7 million or 11.4% of all African Americans aged 20 years or older have diabetes, but one-third of them are unaware of their diagnosis Sources: ADA, CDC

18. Source: MDPH, Massachusetts Hospital Discharge Data, Fiscal Year 2001

19. Cigarette Smoking Cigarette smoking rates are similar among white and black residents of Massachusetts Whites are more likely to quit smoking than blacks

20. Source: MDPH, 2000 Behavioral Risk Factor Surveillance Survey

21. High Blood Pressure (Hypertension) Those with high blood pressure may have 3-4 times the risk of CHD and 7 times the risk of stroke than those with normal blood pressure The prevalence of high blood pressure among U.S. blacks is among the highest in the world Blacks are more likely to develop high blood pressure at an earlier age and to have higher blood pressure than whites Black women in the U.S. have the highest incidence of hypertension of any race-sex group Blacks are less likely to have their hypertension controlled than whites, with black women being the least likely (He J et al, Arch Intern Med, 2002;162) Source: US DHHS

22. Source: MDPH, Massachusetts Hospital Discharge Data, Fiscal Year 2001

23. High Blood Cholesterol Among African Americans in the U.S., 45% of men and 46% of women have high blood cholesterol A 10% decrease in total cholesterol levels may result in an estimated 30% reduction in the incidence of coronary heart disease Blacks tend to have lower blood cholesterol levels than whites

24. Source: CDC/MDPH, BRFSS 2001

25. Screening & Treatment Blacks are less likely to receive major procedures diagnosing and treating coronary heart disease than whites Black women are the least likely to have such procedures recommended Sources: Schulman KA et al, N Engl J Med 1999;340(8); Ayanian JZ et al, JAMA, 1993;269,20; Giles et al, Arch Intern Med 1995;155(3); Johnson PA et al, Ann Intern Med 1993;119(8))

26. Policy Considerations Access to medical care Adoption of standards and guidelines for prevention, detection, treatment and rehabilitation of heart disease for all patients Physician diversity and resident training in cultural and gender competence Re-investment in tobacco prevention and cessation initiatives Improved access to high quality, heart healthy foods, especially in rural and urban low-income areas Increased access to safe walking/activity areas and promotion of innovative strategies to facilitate exercise time

27. Contact Information Paula A. Johnson, MD, MPH Chief, Division of Women’s Health; Executive Director, Connors Center for Women’s Health and Gender Biology Brigham and Women’s Hospital Phone: (617) 732-8985, Fax: 264-5191 Email: PAJohnson@partners.org Rachel A. Wilson, MPH Director of Women’s Health Policy and Advocacy Brigham and Women’s Hospital Phone: (617) 525-7516, Fax: (617) 525-7746 Email: rwilson1@partners.org