JACC Report Card Documents Excess CV Mortality Among Black Americans

Black Americans suffered nearly 800,000 excess age-adjusted deaths and 24 million excess years of potential life lost due to cardiovascular disease from 2000 to 2022, compared with their White counterparts, according to a study published in JACC on June 18, the day before Juneteenth.

Adith S. Arun, BS; Harlan M. Krumholz, MD, SM, FACC, et al., looked at national death certificate data from the U.S. Centers for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research, comparing outcomes in non-Hispanic Black and non-Hispanic White populations whose primary cause of death was cardiovascular disease. Patient age ranged from 20 to 84 years and the investigators stratified the data by five-year age groups, race, gender and year. Ischemic heart disease, hypertension, cerebrovascular disease and heart failure were the specific disease types included in their analysis.

The authors calculated age-adjusted mortality rates and years of potential life lost for overall cardiovascular disease along with each disease condition. They found that for overall cardiovascular disease, excess age-adjusted mortality rates decreased from 2000 to 2011/2012, plateaued for several years, and then increased in 2020 before returning to prepandemic levels in the following two years. This trend was observed in both women and men.

When comparing the impact of cardiovascular disease among Black vs. White Americans, the authors estimate 779,387 excess deaths and 23.7 million excess years of potential life lost in the Black population. Broken out by sex, 362,887 excess deaths and 11.2 million excess years of potential life lost were experienced among Black women while 416,500 excess deaths and 12.5 million excess years of potential life lost were experienced by Black men.

"Despite the triumphant reduction in cardiovascular morbidity and mortality over the last 50 years, those declines evolved at racially disproportionate rates resulting in not just health inequities, but life inequities," write the authors. "The disparities are evident across different subcategories, including ischemic heart disease, hypertension, cerebrovascular disease and heart failure."

In an accompanying editorial comment, Jennifer H. Mieres, MD, FACC; Jeffrey T. Kuvin, MD, FACC; and Robert O. Roswell, MD, FACC, add: "As we observe Juneteenth 2024, the work by Arun, et al., shows that much is needed to achieve equitable health care for Black Americans. However, with the implementation of digital innovations through a lens of health equity and a comprehensive [cardiovascular] quality and equity effort, in a decade one hopes we will look at a report card for 2022-2032 and see that the gaps in [cardiovascular disease] mortality between Black and White Americans have been attenuated or resolved."

According to Melvin R. Echols, MD, FACC, chief diversity, equity, and inclusion officer of the ACC, "Although we celebrate Juneteenth for its symbolic representation, this is also a time to reflect on the important health care decisions that exacerbate the struggles that Black people have faced in America. Recognizing the impact of health care on the Black community is just the first step. We will continue to witness these devastating trends if we fail to address these issues effectively as a society and a country. Health justice advocates are crucial, but the decision-makers and leaders of health care must commit to health equality and equity, placing personal views aside to help all Americans individually achieve their best health."

"Only through dedicated and coordinated action can we achieve equitable health outcomes for all," adds Krumholz.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Hypertension

Keywords: Health Equity, Hypertension, Heart Failure

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