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Racial Disparities in Health Care: Amputation, Heart Health, and COVID-19

Apex Heart and Vascular Center Team promoting heart health and health disparities in African Americans

RACE AND HEALTH CARE DISPARITIES DURING COVID-19:

Coronavirus brought racial disparities in health care to the forefront. Here’s how.

AMPUTATION, DIABETES, AND PERIPHERAL ARTERIAL DISEASE

Racial inequality in America is an issue that has mainstream media attention right now. Both political parties are talking about systemic issues in racial equality in The United States.  However, I do not think this conversation is complete without addressing racial inequality in health care, specifically pertaining to amputation, diabetes, and Peripheral Arterial Disease (PAD) in the African American community.

If you are African American or Latino, your risk of Peripheral Arterial Disease, diabetes, and amputation is astronomically high. Unfortunately, people of color have shown worse outcomes with COVID-19. These conversations are tied together and coronavirus has brought racial disparities in health care to the forefront.

In a recent Instagram Live with Bergen in Color, we discussed:

  • Heart health risks and health care disparity in the African American community
  • Racial bias African Americans face when visiting the doctor
  • COVID-19 impacts on the African American community

How to reduce racial disparities in health care: [VIDEO]

Unequal medical treatment: confronting racial and ethnic disparities in health care

Cardiovascular health in the African American community is important because I have spent my life working in amputation prevention. Unfortunately, amputation is a significant issue in the African American community. If you are African American, your likelihood of developing peripheral arterial disease, diabetes, and getting an amputation is significantly higher than your non-African American counterpart and it’s not just numbers2.

When I saw the disparity in terms of how African Americans were afflicted with COVID-19 at a higher rate, it broke my heart, but I wasn’t surprised. My offices in Bergen County and Irvington, New Jersey, are predominantly African American populations.  With patients at these office locations, we see a lot of heart disease and circulation problems such as diabetes and peripheral arterial disease (PAD).  As doctors, we know that if you get an amputation, your risk is as high as stage four cancer8. For people who get an amputation, the mortality rate is exceptionally high.

At the time of this writing, in the United States, 164,000 people have died from COVID-193, but if you look at the African American population, the age-adjusted mortality rate was 3.7 times higher than that of white Americans4.

What does this mean? If you are African American, you are three times more likely to die from COVID-19 than your non-African American counterpart. These statistics are not surprising because all the risk factors happen to be more common in the community.

Heart health in the African American community

Why are African Americans at a greater risk for health problems and heart disease?

We have to accept the reality that African Americans are a more vulnerable population by the nature of race, lifestyle, and genetic risk factors. You can still choose to have a healthier lifestyle, get early detection, get screening, and actively work on preventative cardiovascular measures. If you have cardiac symptoms, don’t ignore them and find a cardiologist who is going to believe you and who will do their due diligence to get the medical issues properly diagnosed, treated and fixed.

African American health disparities

The African American community faces severe health challenges, including but not limited to:

  • A higher rate of obesity
  • A higher rate of diabetes
  • A higher instance of cardiovascular disease than the rest of the population1.

African American heart disease statistics

  • In 1950, African Americans and white Americans were at a similar level of risk for heart disease, but by 2000 African Americans became 30% more likely to develop heart disease17.
  • African Americans are 40% more likely to have high blood pressure, and less likely to have it managed than non-Hispanic whites
  • African Americans are 20% more likely to die of heart disease19.
  • African Americans are at increased risk for hypertension, obesity, high cholesterol, and cigarette smoking, all risk factors for heart disease19.
  • African Americans are at increased risk for adverse outcomes, including death, after undergoing procedures like percutaneous coronary intervention, compared to white patients20.

How doctors can respond to implicit bias in health care

For residents of Irvington, Passaic, and Patterson, New Jersey, some things must take place structurally and socially so that residents can have a chance at better health outcomes.

It is essential to change things at an individual, community, and society level. Even more critical is making changes at a government level.

Unfortunately, we know that if African Americans have medical symptoms, they are not taken as seriously.

My colleagues in the medical field are at fault because multiple studies have proven that in health care, your genetic code matters, but what matters more than the genetic code is the zip code you live in and the color of your skin5.

I always say that every heart is the same color, but in reality, if your skin color is different, then your heart gets different treatment.

Dr. Anuj Shah quote "Every heart is the same color"

Examples of racial disparities in health care

If you are African American and you complain of pain, you are less likely to be taken seriously6. We have seen this across the board. I see it in cardiology all the time, especially if you are a woman and you complain of chest pain.

If you are a Black woman and you go to the emergency room for chest pain, the chances are that you will be discharged saying, “Oh, this is gastritis, or this is some kind of discomfort.” African Americans get fewer pain meds, less testing, and less screening6.

We even see this in cesarean sections. Unfortunately, the color of your skin impacts your medical treatment because the cesarean section and maternal mortality rates are very different and were highest in the African American community from 2008-20187.

This disparity in medical treatment is across the board from obstetric issues in childbirth to amputation and ventral vascular disease.

Maternal and infant mortality rates for African Americans

  • In 2018, African American women died from maternal causes at a 2.5 times higher rate than white women
  • African American mothers are at increased risk for health conditions, such as obesity and hypertension, and their likelihood of having access to quality prenatal care is lower than their white counterparts
  • The CDC did a study of  3,000 pregnancy-related deaths, from 2011 to 2015 and found that out of 250 deaths, 60% of them were preventable
  • African American infants have an infant mortality rate 3 times that of Caucasian infants and are 3.8 times more likely to die from low birthweight complications11
  • In 2017, African American mother’s likelihood of not receiving prenatal care until late-term or at all was 2.3 times higher than non-Hispanic white mothers11.
  • African American women in the United States face worse birth outcomes and conditions associated with low birth weight, hypertensive disease, and preterm delivery, than their counterparts born outside of the United States12.
  • American women, regardless of race, experience the highest rate of maternal mortality due to complications from pregnancy or childbirth12.

If you are an African American with diabetes, end-stage renal disease, or dialysis, you are at greater risk13. I am sure every African American person knows somebody in their family who is on dialysis. As a society, this plays a role at an organization level of what changes need to be made. We need awareness in the community and that starts at the family level.

For example, young people can take a greater interest in the elderly and make sure that they are getting screening for their blood pressure, checking their cholesterol, getting electrocardiograms, and doing stress tests. High blood pressure is the leading cause of death in African Americans and needs to be taken seriously to prevent heart attacks and strokes14.  The medical community needs to be educated that if your patient is a particular ethnicity, you need to pay more attention to any risk factors such as diabetes.

“My husband is also a physician and he had to take a course where everyone learns about implicit bias. One of the things that we’ve been talking about is how the strong black woman trope is what’s causing this internal bias to say, “Okay, well, they don’t need as much attention as far as pain meds”, or, “Maybe she’s just anxious and she’s not having a heart attack. How does the medical community talk to each other about this and try to change these perceptions? Because if I feel pain and someone who has blonde hair and blue eyes feels pain, it should be treated the same and it’s not.”- Tevra Francis/ Bergen in Color 

Implicit racial biases that African Americans face in the health care system

Training for implicit bias is a significant step forward in this direction. I don’t think people mean ill will. People do mean well in the medical community, but unfortunately, sometimes they don’t have these important issues on their radar, which is why the need for education is so critical.  If someone with blonde hair and blue eyes is having pain and someone with darker skin is having pain, not only should they both be taken seriously, but sometimes the latter has to be taken even more seriously because there are inherent risk factors such as being overweight, a higher risk of smoking, hypertension, or inherent kidney problems14. This is especially true with a patient population that is sixty-five plus years old.

Racial bias in health care statistics

  • A study in the American Journal of Public Health found that some white health care providers view African American patients as less intelligent and therefore, less likely to adhere to treatment protocols15.
  • Minorities cite being less satisfied in their interactions with health care providers, due to implicit biases held by healthcare providers and less patient-centered care, than non-Hispanic white patients15.
  • Implicit bias towards minorities by health care providers has been attributed to longer wait times before assessment or treatment and shorter patient-physician interactions for minorities15.
  • In 2017, 10.6% of African Americans did not have health insurance, compared to 5.9% of non-Hispanic whites being uninsured16.
  • Identified discriminatory health practices by physicians include discrepancies in access to health care, variations in health care provider’s behavior, and socioeconomic discrimination17.
  • Experience with race-based discrimination can be linked to physiological responses, such as elevated blood pressure and heart rate, which can eventually result in disease and higher death rates17.

COVID-19 cardiovascular impact on the African American community

Change can only come from raising awareness and creating a dialogue where the issue of healthcare disparity in the African American community can be brought to the forefront of everyone’s attention.

 

NEW JERSEY VASCULAR SCREENING

If you are concerned about your cardiac health, please reach out to us. We can see you in person at our cardiology office in Passaic, New Jersey or we can offer you Telehealth services.  You should be screened for cardiac and vascular conditions such as PAD and PVD. Contact us today to book an appointment.

 

AFRICAN AMERICAN HEALTH AND CORONAVIRUS RESOURCES:

Study shows known racial disparities in cardiovascular risk and outcomes extend to PCI outcomes

  1. Epidemiology of Obesity and Diabetes and Their Cardiovascular Complications
  2. Disparities in Amputations in Minorities
  3. COVID-19 Cases and Deaths in the US
  4. The Color of Coronavirus: COVID-19 Deaths By Race and Ethnicity In The U.S.
  5. Why Your Zip Code Matters More Than Your Genetic Code
  6. Racial and Ethnic Disparities in Diagnosis and Treatment: A Review of the Evidence and a Consideration of Causes
  7. Percentage of live births by cesarean delivery in the United States from 2008 to 2018, by ethnicity
  8. Five-year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer
  9. S. Maternal Mortality Data: Black Mothers Fare the Worst
  10. S pregnancy deaths are up, especially among black women
  11. Infant Mortality and African Americans
  12. Why Black Women Face More Health Risks Before, During, and After Pregnancy
  13. Association Between Renal Failure and Foot Ulcer or Lower-Extremity Amputation in Patients With Diabetes
  14. African Americans and Kidney Disease
  15. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes
  16. Health Disparities by Race and Ethnicity
  17. Race, Race-Based Discrimination, and Health Outcomes Among African Americans
  18. Global evaluation of echocardiography in patients with COVID-19
  19. Heart Disease and African Americans
  20. Black patients have higher rates of death after PCI

 

HEART AND VASCULAR SPECIALIST IN NEW JERSEY | ABOUT DR. ANUJ R. SHAH 

Dr. Shah is an interventional cardiologist and endovascular specialist originally trained at Mt. Sinai. He has been a heart and vascular specialist for 11 years and is passionate about cardiovascular health and amputation prevention. He is currently the Director of Apex Heart and Vascular and has privileges at Mount Sinai as an assistant professor. He is a regional authority on interventional heart and vascular treatment and is frequently featured in the media and podcasts to discuss the importance of cardiovascular care.

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