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Last week’s election results may indicate that there are political winds diverting attention from diversity, equity and inclusion, but new research papers once again make clear that people in different socio-economic groups have different health outcomes of concern.
These four papers, published Monday in scientific journals before being presented later this week at the American Heart Association scientific sessions in Chicago, focus on health disparities and link who people are to how they fared:
Cardiac care before delivery helped white, but not black, mothers with preeclampsia
We know that black women do much worse before and after giving birth than white women. The specific problem of preeclampsia and eclampsia, which manifests late in pregnancy as extremely high blood pressure, is more severe in black women and is 60% more common than in white women. Preeclampsia, a leading cause of maternal mortality, increases the risk of heart attack, stroke, heart failure and death; more than half occur within the first two weeks after delivery. Black women are more likely to have these complications, even after accounting for socioeconomic factors or existing health conditions.
Cardiology care before delivery is intended to reduce that risk, but a study of the medical records of nearly 30,000 insured patients found that serious cardiovascular events were more common in black patients than in white patients in the first year after delivery, despite they received this care. This cardiology care before delivery – something only 1 in 9 patients with preeclampsia receive – was linked to a 69% lower risk for white patients, but not for black patients.
Surprisingly, Ikeoluwapo Bolakale-Rufai of Northwestern University, lead author of the book, saw no effect for black patients. study appearing in Circulation: Cardiovascular Quality and Outcomes. She called for further research to answer the question.
“We hypothesized that receipt of cardiology care will reduce the risk of major cardiovascular events for both black and white patients,” she wrote in an email to STAT. “We believe additional strategies such as multidisciplinary care, optimal timing of care, and equitable antiracist treatment may be necessary to increase the impact of cardiology care for Black patients.”
Black veterans were less likely to be prescribed weight loss medications
Powerful new anti-obesity drugs have the potential to improve cardiovascular and metabolic health, but barriers are high for drugs that are difficult to find and afford. Researchers turned to the VA system — which has no insurance limits for care — to see whether race or ethnicity changed who was prescribed semaglutide, sold as Ozempic for diabetes and Wegovy for obesity.
Although obesity disproportionately affects people who are part of the minority population, black veterans with obesity and type 2 diabetes were less likely than white veterans with those conditions to receive semaglutide, the researchers said. report in Circulation: Cardiovascular Quality and Outcomes. The greatest undertreatment occurred in people with diabetes, the condition for which semaglutide was first approved. There was no difference between Latino and white veterans, whether they had diabetes or not.
“The differences were greater among people with both obesity and diabetes, who would benefit most from treatment with semaglutide,” study author Rebecca Tisdale of the VA Palo Alto Health Care System told STAT. “We would like these findings to inform policy around the allocation of scarce drugs such as semaglutide and the related tirzepatide. If equity is not part of the discussion, expanding semaglutide could paradoxically worsen existing disparities in obesity rates among race and ethnicity groups.”
Social needs prevent heart failure patients from benefiting from quadruple therapy
Deaths from heart failure have increased since 2012, undoing years of progress and getting even worse since 2020. Only 1 in 5 patients with a type of heart failure classified as reduced ejection fraction receives all four forms of guideline-directed medical therapy. A new study in Circulation: heart failure asks why people don’t get this quadruple therapy, which includes drugs known as renin-angiotensin system inhibitors, beta blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors. It is estimated that the oral medications could reduce deaths by 73% in two years.
In their search for an explanation for the low use of quadruple therapy, the researchers looked at race and ethnicity, gender and social determinants of health, social needs and insurance status among nearly 83,000 people admitted to hospitals with heart failure as a primary diagnosis.
The results: Black and Hispanic individuals had better use of quadruple therapy for heart failure with reduced ejection fraction compared to white individuals, and women scored better than men. People were less likely to receive quadruple therapy if they had Medicaid, Medicare or no insurance, compared to people with private insurance. Overall, people with adverse social determinants of health were the least likely to benefit from quadruple therapy.
Cardiology fellows give mixed reviews of their programs’ DEI efforts
As affirmative action disappears from college admissions policies, efforts at the graduate level to promote diversity, equity, and inclusion may face setbacks in the future. A piece of paper in the Journal of the American Heart Association looks at cardiology fellowship programs through the eyes of fellows themselves.
A small sample of 101 fellows recruited by the CardioNerds platform – which aims to promote diversity – responded to a survey in 2021 asking them to rate their cardiology programs. Originally founded to diversify the physician workforce and combat racism, these efforts may fall short in the eyes of the fellows. The breakdown:
- 67% felt that health equity was valued by their program
- 65% considered health diversity and equity priorities of their programs
- 30% did not feel supported by the culture of their institution
- 49% believed that social determinants of health and health disparities were routinely discussed as part of their curriculum
- 43% thought the health disparities curriculum was sufficient
- Overall, 58% said physicians in leadership positions looked like them, but 92% of Black fellows disagreed
The authors of the article note that a 2020 survey among cardiology training directors found that less than half believed that curricular interventions were useful tools to support diversity and inclusion. “Continued efforts must be made to uphold a core mission of DEI where diversity is not only valued but also actively promoted,” the authors of the new article wrote.
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