New research that will be presented during ACC.21 addresses social factors like education, financial security and the neighborhood where a person lives that may pose barriers to accessing cardiovascular care among high-risk, disadvantaged groups.

One study, that was simultaneously published in Circulation: Cardiovascular Quality and Outcomes, showed that these factors were strongly correlated with whether or not individuals with cardiovascular disease adopted measures to prevent the spread of COVID-19, including wearing masks and working from home. "Unless we look at COVID-19 through the lens of social determinants of health, we may not optimize our yield from interventions, and we might not be reaching the group of individuals who need these interventions the most," said Kobina Hagan, MD, MPH, the study's lead author.

The research, based on data from 2,000 participants in the COVID-19 Household Impact Survey who reported a history of cardiovascular disease, myocardial infarction (MI) or stroke, found that compared to those with the most favorable social risk profile, those with the greatest social adversity were 31% less likely to engage in all social distancing measures (canceling or postponing social activities and avoiding crowded public places, restaurants and contact with high-risk people) and 17% less likely to engage in all personal protective measures (wearing a face mask, washing hands and keeping a 6-foot distance from those outside their household). These differences remained significant even after accounting for demographics and comorbidities.

"We as a society have ignored all the disparities and inequities that were happening during calmer times, even in cardiovascular disease," Hagan said. "We need to focus on holistic strategies to effectively fight this pandemic and ensure those not afforded the privilege of personal protection, social distancing and work flexibilities are prioritized with vaccine outreach to avoid further compounding existing health inequalities."

A separate study found that Black patients from disadvantaged neighborhoods were significantly more likely to die within five years of surviving a MI compared with Black MI patients from wealthier neighborhoods and white MI patients of any socioeconomic means. Researchers analyzed data from nearly 32,000 patients with health insurance treated for a MI within the Kaiser Permanente Southern California hospital system between 2006-2016.

According to the researchers, the study underscores the influence of a person's environment on their health and suggests that a greater focus on addressing social disadvantages and poverty could help improve outcomes. "A key takeaway from our study is that there are a lot of social and environmental factors that can affect a person's outcome after a heart attack," said Jesse Goitia, MD, the study's lead author. "I think that a broad, overarching approach to start addressing those factors at the neighborhood level would pay dividends for businesses, health insurers, providers and patients."

Another study found young Black women had a high prevalence of obesity, elevated blood pressure and other lifestyle-related factors that may put them on a trajectory to develop cardiovascular disease at a young age. The researchers found high rates of lifestyle-linked risk factors among Black women as early as their 20s and 30s.

"Young people should be the healthiest members of our population with normal body weight and normal blood pressure," said Nishant Vatsa, MD, the study's lead author. "We're finding obesity and elevated blood pressure are present in women even at younger ages, which is worrisome. Thus, interventions like educating young women, especially Black women, about healthy dietary choices and the benefits of exercise, improving access to health care and enhancing the ability for people to adopt healthy practices – such as increasing access to healthy foods and safe areas for physical activity – needs to start early."

While Vatsa and colleagues believe the observed trends are likely reflective of the broader population of Black women, they plan to compare their findings with studies from other regions of the U.S. and other racial and ethnic groups for additional insights.

Access a complete listing of ACC.21 sessions addressing diversity, equity and inclusion, here.

Clinical Topics: Cardiovascular Care Team, COVID-19 Hub

Keywords: ACC Annual Scientific Session, ACC21, Blood Pressure, African Americans, Poverty, COVID-19, Health Status Disparities, Social Determinants of Health, Obesity, Stroke, Myocardial Infarction, Vaccines

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