FACTS - PDF Document

Presentation Transcript

  1. FACTS Bridging the Gap CVD Health Disparities A person’s race or ethnicity shouldn’t put them more at risk for having heart disease or stroke, but unfortunately, it is one factor that affects a person’s likeliness of suffering a heart attack or stroke and chances of survival if they do. Cardiovascular disease (CVD), including heart disease and stroke, remains the No. 1 killer of Americans1 and exacts a disproportionate toll on many racial and ethnic groups2 that have higher rates of CVD and its risk factors. For example CVD accounts for about one-third of the disparity in potential life-years lost between blacks and whites.3 In addition, racial and ethnic minority populations confront more barriers to CVD diagnosis and care, receive lower quality treatment, and experience worse health outcomes than their white counterparts.4 Such disparities are linked to a number of complex factors such as income and education, genetic and physiological factors, access to care, and communication barriers.4,5 The American Heart Association (AHA) believes that it is time to bridge the disparity gap and ensure access to quality health care for all who live in the United States. GREATER RISKS, GREATER DEATHS Many racial/ethnic minority populations have higher rates of CVD and related risk factors. The statistics are stark testimony to that fact. •CVD age-adjusted death rates are 33% higher for blacks than for the overall population in the U.S. •Blacks are nearly twice as likely to have a first stroke and much more likely to die from one than whites.1 •American Indians/Alaska Natives die from heart disease much earlier than expected – 36% are under 65 compared with only 17% for the U.S. population overall.7 •High blood pressure is more prevalent in certain racial/ethnic minority groups in the U.S., especially blacks.1 •Non-Hispanic blacks, Mexican-Americans, American Indians, and Alaska Natives have a higher prevalence of diabetes than non-Hispanic whites for adults over age 20.1 •Non-Hispanic blacks and Mexican American women have a higher rate of obesity, a risk factor for CVD and diabetes, than non-Hispanic white women.1 Utilization Rates for Preventive Services by Racial/Ethnic Group 100% 80% White only, Non-Hispanic Black only, Non-Hispanic Hispanic 60% 40% 20% Asian Only 0% Cholesterol Screening (Men 35+, Women 45+) Aspirin Use Among Adults (Men 40+, Women 50+) Hypertension Screening (Adults 1 8+) Source: Partnership for Prevention. Preventive Care: A National Profile on Use, Disparities, and Health Benefits, 2007. LOWER ACCESS, LOWER QUALITY Racial/ethnic minority groups more frequently lack health insurance and have limited access to quality health care.9 •A 2007 U.S. Census Bureau report showed that more than half of the uninsured are people of color.10 •A recent survey found that Hispanics and blacks are less likely than whites to have access to a regular source of medical care, but having health insurance and a medical home can reduce or eliminate disparities in access and quality.11 •A recent report on cardiac care quality of racial/ethnic minority groups found evidence of disparities in 84% of the studies examined.12 •Evidence suggests black adults are far more likely than white adults to be admitted to the hospital for angina and congestive heart failure.13 •A study on cardiovascular procedures found blacks were more likely than whites to be American Heart Association ? Advocacy Department ? 1150 Connecticut Ave. NW ? Suite 300 ? Washington, DC 20036 Phone: (202) 785-7900 ? Fax: (202) 785-7950 ? www.americanheart.org/yourethecure

  2. FACT SHEET: CVD Health Disparities admitted to an emergency room and had higher post-operative mortality rates.14 •The National Healthcare Disparities Report, 2007 found that the proportion of Medicare patients with heart failure who received the recommended hospital care was lower for American Indians/Alaska Natives and Hispanics, compared to whites.15 •Disparities are also linked to minority patients receiving care in lower-performing hospitals.16 HEALTH CARE WORKFORCE There are fewer minority physicians and limited awareness among cardiovascular practitioners about health care disparities. •Minorities are greatly underrepresented in the U.S. physician workforce. In 2001, only 2% of cardiologists were black, 3.8% were Hispanic, and 12.7% were Asian.17 •In 2004, almost two-thirds of U.S. medical school graduates were white. Only 6.3% were black, 6.2% were Hispanic/Latino, and less than 1% were Native American.18 •Many minority patients have difficulty communicating with their health care providers.5 •Just 35% of cardiologists recently surveyed agreed that disparities in overall care exist in the U.S., and only 5% believed disparities exist in the care of their own patients.19 MORE AND BETTER DATA NEEDED •A recent review of racial/ethnic differences in cardiac care showed that 91% of high quality studies included data on blacks, but only 26% on Hispanics, 14% on Asians, and a mere 5% on Native Americans.12 2003 Minority Health Summit In 2003, the AHA convened a 3-day summit to examine CVD health care disparities and assist in developing the next phase of the AHA's scientific, programmatic, and advocacy agendas addressing these issues. The recommendations included:4 •Increase research on genetic and environmental factors that contribute to racial/ethnic health disparities and increase the participation of minorities in research and as investigators •Increase the number of racial/ethnic minorities who work in health care and improve cultural competency among health care providers •Increase CVD screening and prevention •Improve minority access to quality care •Stratify and report data by racial/ethnic groups, and when possible report data in the primary language patients speak. •Provide patients and the public with culturally and linguistically appropriate health care and educational materials. •No standardized requirement exists in the health care industry for collecting, categorizing or using race/ethnicity data.9 THE AHA ADVOCATES The AHA and its American Stroke Association division supports: •Meaningful, affordable, high quality health care coverage for all U.S. residents. •The Minority Health Improvement and Health Disparity Elimination Act of 2007 and the Health Equity and Accountability Act, which would increase health care workforce diversity and competence, promote health care access and awareness among minorities, further research, and create a plan to reduce health disparities. •The Indian Health Care Improvement Act of 2007, which would help reduce health disparities among Native Americans and Alaska Natives. •Promoting health information technology use, which would help reduce health disparities and ensure that patients with CVD receive recommended care. The AHA/ASA has demonstrated that clinical decision support tools, such as its Get With The Guidelines can improve the quality of care that coronary artery disease, heart failure, and stroke patients receive. References 1. Heart Disease and Stroke Statistics – 2009 Update: A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008. 2. Mensah, G., Mokdad, A, et al. State of Disparities in Cardiovascular Health in the United States. Circulation. 2005; 111:1233-1241. 3. Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contributions of major diseases to mortality. New England Journal of Medicine. November 14, 2002; 347:1585-93. 4.Bonow, R., Grant, A., Jacobs, A. The Cardiovascular State of the Union: Confronting Healthcare Disparities. Circulation. 2005: 111; 1205-1207. 5. Yancy C, Benjamin E., et al. Discovering the Full Spectrum of Cardiovascular Disease: Minority Health Summit 2003: Executive Summary. Circulation. 2005; 111; 1339-1349. 6. Kung H-C, Hoyert DL, Xu J, Murphy SL. Deaths: final data for 2005. National Vital Statistics Reports: CDC; January 2008, 56(10). 7. Centers for Disease Control and Prevention. Disparities in premature deaths from heart disease, 2001. MMWR 53(6):121-125. 8.National Center for Health Statistics. Health, United States, 2007. Hyattsville, MD: 2007. 9. Angeles J, Somers S. From Policy to Action: Addressing Racial and Ethnic Disparities at the Ground-Level. Issue Brief. Center for Health Care Strategies, Inc. August, 2007. 10. Income, Poverty, and Health Insurance Coverage in the United States: 2007. U.S. Census Bureau. 2008. 11. Beal A, Doty M, et. al. Closing the Divide: How Medical Homes Promote Equity in Health Care: Results from the Commonwealth Fund 2006 Health Care Quality Survey. The Commonwealth Fund, June 2007. 12. The Kaiser Family Foundation and the American College of Cardiology Foundation. Racial/Ethnic Differences in Cardiac Care: The Weight of the Evidence. (Report #6040) Available at: www.kff.org. 13. Holmes J, et. al. Heart disease and prevention: race and age differences in heart disease prevention, treatment & mortality. Medical Care 2005, 43(3) suppl.. 14.Lucas F, et. al. Face and surgical mortality in the U.S. Ann Surg 2006. 243(2). 15. National Healthcare Disparities Report, 2007. Agency for Healthcare Research and Quality. February, 2008. 16. Hasnain-Wynia, Romana, et. al. Disparities in Health Care are Driven by Where Minority Patients Seek Care. Arch Intern Med 2007, 167;1233-1239. 17. Francis C, et al. Working Group 3: How to Encourage More Minorities to Choose a Career in Cardiology. JACC; Vol. 44, No. 2., 2004. 18. Minorities in Medical Education: Facts & Figures, 2005. Association of American Medical Colleges. 19. Lurie, N., et. al. Racial and Ethnic Disparities in Care: The Perspectives of Cardiologists. Circulation. 2005; 111: 1264-1269. 20. Yancey A, et. al. Discovering the Full Spectrum of Cardiovascular Disease: Minority Health Summit 2003: Report of the Advocacy Writing Group. Circulation 2005; 111;140-149. •The proportion of people in the U.S. who are members of at least two ethnic groups will increase 10% by the year 2050, complicating assessments of health disparities. 20