Researchers are struggling to make sense of recent studies on racial differences in medical treatment. This is in light of statistics showing a higher percentage of heart-related illness among black Americans, as compared to white Americans. Scientists have explored the medical and social factors that may explain the disparities in medical care.
In the United States, studies have shown that some racial and ethnic groups fare better during the course of the disease, that ethnic groups respond differently to some treatments, and that some ethnic groups tend to be diagnosed later in their diseases than others. This issue is of particular concern to black Americans, who tend to lag behind white Americans and other ethnic groups in their access and reliance on prompt medical care.
Differences in care for black Americans
A number of recent studies have explored presumed or apparent differences in diagnosis and medical treatment in black Americans. These include:
A study found that symptoms or causes of heart failure differ among black American and white patients. For example, black American heart failure patients tended to have high blood pressure and abnormal heart rhythm (arrhythmia), whereas whites had coronary artery disease. Despite these clinical differences, researchers found no significant disparity in survival between black American and white heart failure patients.
In another recent study, a research team compared the effectiveness of electrophysiology therapy, antiarrhythmic drugs or implantable defibrillator (ICD) in black American and white patients having arrhythmia. In evaluating how well the drugs performed in correcting the abnormal heart rhythm, black American patients responded better to the antiarrhythmics than did white patients. An ICD was offered to all patients who did not respond to antiarrhythmics. It was noted that 7 percent of the white patients refused an ICD, and 20 percent of the black American patients refused. The researchers could only speculate on causes for the high rate of refusal (e.g., cultural, educational, religious factors).
The disparity in survival between white and black American heart failure patients is largely a reflection of access to health care, according to another study. Records of more than 29,000 hospitalized Medicare heart failure patients between 1998 and 1999 were analyzed. It was shown that not only did black American patients receive the same therapy (ACE inhibitors) as white patients, but the death rate among black Americans after one month and one year was lower than for white patients.
The International Society on Hypertension in Blacks notes that less than 25 percent of hypertensive black Americans have their blood pressure under control. Moreover, high blood pressure (140/90) in black Americans is a problem at younger ages, as compared to white Americans. The society recommends antihypertensive medication as soon as blood pressure is 130/80; this is recently designated as “prehypertension.” This should be combined with exercise, low-salt diet, and smoking cessation with the goal of maintaining blood pressure at 120/80.
According to the U.S. Centers for Disease Control and Prevention (CDC), African American adults 35 years of age and older who live in some Southern states (North and South Carolina, and parts of Georgia, Arkansas, Mississippi and Tennessee) have had a higher risk of death from stroke than anyone else in the country. This may reflect, researchers believe, inadequate information on stroke prevention provided to certain communities, as well as less access to healthcare.
Making sense of these sometimes conflicting findings can be difficult. Some experts point to lack of (or inadequate) health insurance, difficult access to optimal health care, or racial discrimination as challenges to black Americans that are not typically present in whites. However, other studies have shown that, irrespective of race, anyone living in areas where medical and other community services are lacking tends to have increased risk of disease and complications. Financial burdens, family relationships and responsibilities can also have an impact on that risk.
Tips for improving care
Until the issue has been resolved, Black Americans (like all people) are urged to take steps toward getting the best medical care possible:
Learn as much as possible about the diagnostic tests, treatments and prevention strategies that are currently being recommended for the individual's health condition (this site can be an excellent resource).
Ask questions. Some healthcare providers tend to use medical jargon that is difficult for people of any background to understand. It may be tempting to just nod quietly while someone is rapidly throwing medical jargon at you, but it is very important to ask questions.
Review one's own attitudes toward the medical community. Dealing with issues of fear or distrust in advance could save a life.
Do everything possible to make sure that all family members are continuously covered by health insurance. Although emergencies are generally covered by all insurance policies, some policies have certain restrictions, such as covering a hospital stay for only a certain number of days. Contact the insurance company as soon as possible in a medical situation.
If individuals are unhappy with the treatment given to them or a loved one, they should talk to the healthcare professionals about it and/or get a second opinion.
The ARIC study
Researchers have noted that access to (and results from) health care can differ widely for black Americans as compared to whites. Moreover, large-scale studies of heart disease in Black Americans have been lacking. Even race itself can be an awkward subject to present in a scientific setting.
The Atherosclerosis Risk in Communities (ARIC) Study was undertaken to investigate clinically significant differences between white and black American individuals in heart disease risk factors and incidence.
The study included more than 14,000 individuals (2,298 black American women, 5,686 white women, 1,393 black American men, 4,682 white men) aged 45 to 64 years and having no initial evidence of heart disease. The black American participants were mainly in Jackson, Miss., with some in North Carolina. The white participants resided principally in North Carolina, Maryland and Minnesota. Researchers focused on several risk factors, including high blood pressure, diabetes, cholesterol levels, body mass index and obesity.
Results showed that the rate of heart disease was “somewhat higher” in black American women than in white women, and “slightly lower” in black American men than in white men. The researchers found that high blood pressure was “a more powerful predictor of heart disease in black American women than in other race-sex groups,” and diabetes was a “weaker predictor” in black American women than in white women. Levels of low density lipoproteins (LDLs, so-called “bad” cholesterol) were seen as “almost as strong” a predictor in either race.
In discussing the limitations of their study, the researchers noted that most of the black American participants were from one geographic location. Nonetheless, it was concluded that traditional risk factors in both black Americans and whites should be managed aggressively, particularly the treatment of high blood pressure in black American women.
Questions for your doctor
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to medical care and black Americans:
In general, do individuals from my ethnic group receive the same medical care as others?
How can I be sure that I am getting the best medical care possible?
As a black American, what conditions am I at increased risk for?
Would you ever recommend a different treatment or therapy for me because I am a black American? Why?
Do I need to worry about high blood pressure or stroke?
Are there any signs or symptoms I need to pay particularly close attention to as a black American?
Are there any lifestyle changes I can make to lower my risk of developing a dangerous medical condition?
