Last week’s election results may signal political winds sweeping attention away from diversity, equity, and inclusion, but new research papers again make the case that people in different socioeconomic groups have differing health outcomes of concern.
These four papers, being published Monday in scientific journals before being presented at the American Heart Association’s scientific sessions later this week in Chicago, focus on health disparities, linking who people are to how they fared:
Cardiac care before delivery helped white but not Black mothers with preeclampsia
We know Black women fare far worse than white women before and after childbirth. The particular problem of preeclampsia and eclampsia, which shows up as extremely high blood pressure late in pregnancy, is more severe in Black women, occurring at rates 60% higher than among white women. A leading cause of maternal mortality, preeclampsia heightens the risk of heart attack, stroke, heart failure, and death, with more than half occurring within the first two weeks after delivery. Black women face higher odds of these complications, even after taking into account socioeconomic factors or co-existing health conditions.
Cardiology care before delivery is intended to lessen that risk, but a study of nearly 30,000 insured patients’ health records found that serious cardiovascular events were more common in Black patients than white patients in the first year after delivery despite receiving this care. This pre-delivery cardiology care — something only 1 in 9 patients with preeclampsia receive — was linked to a 69% lower risk for white patients but not for Black patients.
Seeing no effect for Black patients was surprising to Ikeoluwapo Bolakale-Rufai of Northwestern University, lead author of the study appearing in Circulation: Cardiovascular Quality and Outcomes. She called for further research to answer the question.
“Our hypothesis was that the receipt of cardiology care will reduce the risk of major adverse cardiovascular events for both Black and white patients,” she wrote in an email to STAT. “We think additional strategies such as multidisciplinary care, optimal timing of care, and equitable anti-racist treatment may be needed to enhance the impact of cardiology care for Black patients.”
Black veterans were less likely to be prescribed weight loss drugs
Powerful new obesity drugs have the potential to improve cardiovascular and metabolic health, but barriers are high for drugs that can be hard to find and to afford. Researchers turned to the VA system — which has no insurance limits to care — to see if race or ethnicity altered who was prescribed semaglutide, sold as Ozempic for diabetes and Wegovy for obesity.
Even though obesity disproportionately affects people who are part of minority populations, Black veterans with obesity and type 2 diabetes were less likely than white veterans with those conditions to receive semaglutide, the researchers report in Circulation: Cardiovascular Quality and Outcomes. The most significant undertreatment showed up among people with diabetes, the condition for which semaglutide was first approved. There was no difference between Latino and white veterans, whether or not they had diabetes.
“The differences were larger among people with both obesity and diabetes who would have the most to gain from semaglutide treatment,” study author Rebecca Tisdale of the VA Palo Alto Health Care System, told STAT. “We’d like these findings to inform policies around allocation of scarce medications like semaglutide and its relative, tirzepatide. If equity isn’t part of the discussion, expanding semaglutide may paradoxically end up worsening existing disparities across race and ethnicity groups in obesity rates.”
Social needs keep heart failure patients from quadruple therapy’s benefits
Deaths from heart failure have been increasing since 2012, reversing 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 receive all four forms of guideline-directed medical therapy. A new study in Circulation: Heart Failure asks why people aren’t getting this quadruple therapy, which includes drugs known as renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium glucose cotransporter-2 inhibitors. The oral drugs could reduce deaths by 73% over two years, estimates project.
Searching to explain low uptake of quadruple therapy, the researchers looked at race and ethnicity, sex, and social determinants of health, social need, and insurance status among nearly 83,000 people admitted to hospitals with heart failure as their 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 females scored better than males. People were less likely to be on 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 be benefitting from quadruple therapy.
Cardiology fellows give mixed reviews to their programs’ DEI efforts
As affirmative action recedes from college admission policies, efforts at the post-graduate level to elevate diversity, equity, and inclusion may be facing future pushback. A 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 — whose aim is to promote diversity — responded to a survey in 2021 asking them to rate their cardiology programs. Originally created to diversify the physician workforce and combat racism, these efforts may be falling short in the eyes of the fellows. The breakdown:
- 67% believed that health equity was valued by their program
- 65% viewed diversity and health equity as 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 who looked like them, but 92% of Black fellows disagreed
The paper’s authors note that a 2020 survey of cardiology program directors found that less than half believed curricular interventions were useful tools to support diversity and inclusion. “There should be continued efforts to uphold a core mission of DEI where diversity is not only valued but actively fostered,” authors of the new paper wrote.
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