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Monday Jul 17, 2017

Racial Differences in Outcomes Demand Greater Vigilance

My father didn't have a documented history of heart disease. He was never diagnosed as having hypertension, diabetes or other conditions that would have alerted us to the fact that he was at risk. So it was a shock -- and one of the events that led me to the field of medicine -- when he died of a massive heart attack at age 59.  

[Man clutching his chest]

Unfortunately, his story isn't unique.

It's well documented that blacks are more likely than whites to suffer from an array of health conditions(www.webmd.com), including asthma, diabetes, hypertension and lung cancer. However, a study published this month in Circulation(circ.ahajournals.org) makes it clear just how different the outcomes are for black men compared with those for their white peers. Black men ages 45-64 (like my father) are twice as likely to die from a first heart attack.

My father lacked health insurance, so he rarely sought care and missed opportunities for discussions about risk factors and prevention, blood pressure and cholesterol screenings, as well as potentially life-saving treatment that may have resulted from such visits.

It's a familiar story. One of the study's authors said in an interview(www.dailymail.co.uk) that "racial and institutional discrimination" and a lack of access to care are major factors in the wide difference in outcomes. In fact, researchers found that black patients actually have a lower risk for nonfatal cardiac events, but that lack of access to care means that too many black patients aren't properly diagnosed with a heart condition until it's too late.

Researchers said blacks have a higher burden of unfavorable social determinants of health,  and access to care is only one such factor. Others include limited access to nutritious food, social stressors, poor neighborhood safety and lack of recreational facilities.

Education and health literacy also are social determinants of health, and researchers said lack of patient awareness is a potential issue that should be considered regarding this issue. Although most patients likely would recognize that severe chest pain is a symptom of a heart attack, they might be less likely to recognize milder symptoms that could be cause to seek care.

So what can family physicians do? We can make sure our at-risk patients who do seek our care understand the symptoms of a heart attack and know when they need to seek treatment. We also can talk to them about exercise, nutrition, tobacco cessation and other prevention efforts, as well as the importance of follow-up when they are being treated for conditions such as hypertension and diabetes.

Family physicians can incorporate screening for social determinants of health into our practices to identify the types of factors described above, and we can address these issues by working with public health departments, social service agencies and other community resources.

Physicians also can advocate for access to care so that fewer patients fall into the gap of being uninsured or underinsured.

The AAFP recently launched the Center for Diversity and Health Equity to "promote evidence-based community and policy changes that address the social determinants of health and health equity." The center also will develop resources to equip family physicians to help patients, families, and communities with issues related to health equity.

Ada Stewart, M.D., is a member of the AAFP Board of Directors.

Posted at 04:16PM Jul 17, 2017 by Ada Stewart, M.D.

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