Heart disease is the leading cause of death in the United States. The risk of having or dying from heart disease varies by race. Black, Indigenous, and People of Color (BIPOC) are more at risk for complications from heart disease than white Americans. This includes a higher death rate and is partly due to the barriers to healthcare BIPOC groups face.
Heart disease accounts for about 1 in 4 deathsTrusted Source and claims 655,000 lives each year in the U.S.The Centers for Disease Control and Prevention (CDC) state that heart disease is the biggest cause of death for most BIPOC living in the U.S., including the following groups:
This article explains how a person’s race affects their risk for cardiovascular disease.
According to the same data from the CDC, heart disease death rates overall have fallen for white Americans since 1999. However, the rate of heart disease has remained consistent among Black, Hispanic, and Asian American groups.Even though white Americans have the highest rate of heart disease diagnosis, they are less likely than Black Americans to die of the disease.
Risk factors for heart disease
While anyone can develop heart disease, certain risk factors increase the likelihood. These includeTrusted Source:
age, with the risk increasing after the age of 35 years
sex, as males are more likely than females to develop heart disease
a family history of heart disease
However, BIPOC groups have a higher prevalence of certain conditions that raise their risk for developing cardiovascular diseases. These include:
High blood pressure
A 2017 studyTrusted Source that examined high blood pressure prevalence across racial and ethnic groups in New York City found significantly lower rates of hypertension among white Americans, with an overall age-adjusted rate of 27.5%. Black Americans had the highest high blood pressure rate at 43.5%, with a rate of 38% among Asian Americans and 33% among Hispanic Americans.Within each group, there were also significant differences. For example, 43% of people from South Asia and 39.9% from East or Southeast Asia had hypertension.
Many factors other than genetics can lead to a higher risk of BIPOC developing high blood pressure, including racism in healthcare and everyday life.For example, researchers in a 2014 systematic reviewTrusted Source concluded that exposure to perceived racist behavior could lead to an increase in the risk of developing high blood pressure.
Obesity is a significant heart disease risk factor. It may also signal other risk factors, such as a low-quality diet and an inactive lifestyle.According to the CDC, 42.2%Trusted Source of white Americans have obesity, which means they have a body mass index (BMI) over 30. The rate for Black Americans is 49.6%, while Asian adults have the lowest rate, at 17.4%. Hispanic adults have the second-highest obesity rate, at 44.8%.
Higher poverty rates and residential segregationTrusted Source among BIPOC groups in the U.S. can cause higher rates of obesity. This is partly because they may not have easy access to fresh, healthier food and safe places to exercise.
A 2019 studyTrusted Source tracked diabetes rates among 7,575 adults between 2011–2016. The age and sex-adjusted prevalence of diabetes was as follows:
22.1% for Hispanic people
20.4% for Black people
19.1% for Asian people
12.1% for white people
Within groups, there was significant variation. For example, 12.3% of South American Hispanic participants had diabetes compared to 21.7% of Mexican participants.
These disparities happen due to a number of factors, including:
lack of access to quality healthcare and checkups
higher poverty rates among BIPOC groups
higher stress rates among BIPOC groups
Overview of health inequities
Race is a social constructTrusted Source based on skin color rather than genetics or biology. Even where genetic factors do play a role in heart disease, social determinants can affect the severity of the disease and a person’s risk of dying.Many of the risk factors that can lead to cardiovascular disease or complications from the conditions are preventable and exist because of systemic racism.
A number of modifiable factors could help reduce disparities between groups:
Racism causes chronic stress, which can increase the risk of developing heart disease. This occurs through “weathering,” a term that describes the long-term impact of exposure to racial stress on a person’s overall health.
A 2019 study found that out of 2,694 people, weathering contributed to Black Americans having a biological age that was 2.6 years older than their actual age, while white Americans’ biological age was 3.5 years younger.
Racial stress can contributeTrusted Source to the development of disease, including risk factors for heart disease, such as high blood pressure. Directly experiencing discrimination also has this effect. For example, a 2004 study of heart disease rates in Black Americans found that the perception of racial discrimination at work correlated with developing hypertension.
Access to resources
It can be more difficult for individuals from BIPOC groups to access healthcare in comparison to white people. This is true for a number of reasons.For example, residential segregation in the U.S. means that predominantly Black neighborhoods have fewer financial resources and are more likelyTrusted Source to have shortages of doctors. It can also contribute to food deserts, which refers to areas where it is difficult to get fresh produce, and unsafe public spaces, which can affect a person’s ability to exercise.
Economic inequity also contributes to healthcare being unaffordable for many, making it difficult to access or pay for medical treatment. For undocumented migrants, the fear of deportation can deter peopleTrusted Source from seeking help.
Racism in medicine
Numerous studies have found that individuals from BIPOC groups receive lower-quality healthcare than white people.
For example, in an older 2010 studyTrusted Source of people seeking care for pneumonia, Black people were less likely to receive antibiotics within 4 hours. When they did receive antibiotics, the antibiotics were less likely to comply with treatment guidelines. There is no medical reason for this difference.
A 2018 studyTrusted Source found that Black Americans are less likely than white Americans to get care from a cardiologist when they go to the intensive care unit for symptoms of heart failure. Care from a cardiologist correlated with a higher likelihood of survival.
In 2020, the American Heart Association (AHA) emphasized that structural racism is a key driver of disparities in heart disease and heart health outcomes. The organization called for more research on the health effects of racism and urged providers and organizations to examine their role within systemic racism.
One example of an organization that has committed to promoting antiracist policies is The Commonwealth Fund. Measures they call for include:
Improvements in how doctors help individuals from BIPOC groups with chronic conditions, such as high blood pressure, to control their symptoms. This strategy should address the issues of trust that exist between healthcare professionals and BIPOC.
More transparency on racial disparities in the treatment of certain conditions by collating and publishing data.
More information in order to better educate people from all racial groups about factors that could affect their health.
A better understanding of how structural racism affects the way individuals from BIPOC groups can engage with their treatment and healthcare professionals. This could include an acknowledgment of limited public transport and food deserts.