1.6 million excess Black deaths owed to inequities in cardiac care, JACC report card reveals
![The American College of Cardiology (ACC) this week published a report card on highlighting the excess cardiovascular mortality among Black Americans between 2000-2022.[1] The ACC said it highlights the "persistent and tragic inequities" in cardiovascular care and outlines the years of life lost to the Black community because of their higher cardiovascular disease death rates. #healthdisparities](/sites/default/files/styles/top_stories/public/2018-08/blackpatientpills.jpg.webp?itok=6GMknDiV)
The Journal of the American College of Cardiology (JACC) this week published a report card on the excess cardiovascular mortality among Black Americans between 2000-2022.[1] The ACC said it highlights the "persistent and tragic inequities" in cardiovascular care and outlines the years of life lost to the Black community because of higher cardiovascular disease death rates.
The report showed the Black population experienced 1.6 million excess deaths overall and millions of potential life-years lost. Heart disease was the leading cause of age-adjusted excess mortality among Black Americans. This includes deaths due to ischemic heart disease, hypertension, cerebrovascular disease and heart failure.
“Our study reveals that Black Americans, because of their higher cardiovascular mortality rates compared with white Americans, have suffered almost 800,000 excess deaths, which translates to about 24 million additional years of life lost between 2000 and 2022,” JACC incoming editor-in-chief Harlan M. Krumholz, MD, SM, FACC, who is also senior author of the study, said in a statement. “This staggering figure highlights the critical need for systemic changes in addressing cardiovascular inequities.”
Krumholz said the goal of the report card is to promote accountability and serve as a catalyst for action that addresses the ongoing problem.
“We are reminded of the stark reality that Black Americans continue to face significant disparities in cardiovascular outcomes,” explained Jennifer H. Mieres, MD, FACC, in an accompanying editorial.[2] She is the chair of the ACC Diversity and Inclusion Committee and senior vice president of the Center for Equity of Care at Northwell Health in New Hyde Park, New York. She said the report card serves as a reminder that all Americans have not benefited equally from significant advances made in the treatment and prevention of cardiovascular diseases.
“Bringing an equity lens to the redesign of CV health by addressing the social determinants of health and the systemic barriers that contribute to structural racism are critical for solving for cardiovascular health disparities and ensuring equity of care,” Mieres said.
Despite advancements in medicine, access to care has impacted the higher numbers of Black cardiovascular deaths
This report highlights persistent and significant racial disparities in cardiovascular disease outcomes between Black and white Americans. The key finding is that between 2000 and 2022, Black Americans had almost 800,000 excess age-adjusted deaths and 24 million excess years of potential life lost due to cardiovascular disease.
"Despite the triumphant reduction in cardiovascular morbidity and mortality over the last 50 years, those declines evolved at racially disproportionate rates resulting in not just health inequities, but life inequities. The disparities are evident across different subcategories, including ischemic heart disease, hypertension, cerebrovascular disease, and heart failure. Moreover, the sharp increases during the pandemic indicate the specific vulnerability of this group during a public health crisis and the need to mitigate this risk in future pandemics," the authors of the report wrote.
The ACC said in a statement the social determinants of health have a detrimental impact in creating barriers that prevent the most vulnerable Americans from receiving the cardiovascular care they need. The ACC has established multiple programs to address these inequities, including the Diversity and Inclusion Program. Its Internal Medicine Program introduces groups who have been historically underrepresented in cardiology to a career in cardiology by connecting them with the mentors, peer network and resources they need to understand career opportunities in the field.
The ACC Clinical Trials Research (CTR) program is also designed to increase the number of historically underrepresented minorities in cardiology to serve as leaders in cardiovascular clinical trials research to ensure diversity of thought, experience and perspective. The ACC also wants to ensure that the evidence base in studies includes data more closely reflecting the demographics of the actual cardiovascular patient population.
How the study was conducted
Krumholz and fellow researchers used the U.S. Centers for Disease Control and Prevention’s Wide-ranging ONline Data for Epidemiologic Research (WONDER) national death certificate data to collect primary cause of death stats in 5-year age groups from Black and white populations.
They calculated age-adjusted mortality rates (AAMR) for each disease condition by weighting the crude death rate by the fraction of individuals in that age group according to the 2000 population distribution. The excess AAMR was computed by subtracting the estimated AAMR of white people from the AAMR of Black people. Years of life lost (YPLL), defined as the number of years a person would have lived had they not died when they did, was estimated by multiplying the 5-year age group crude mortality rate by the life expectancy of white people for that age group, gender, and year. The excess YPLL was computed by subtracting the estimated YPLL of white people from the estimated YPLL of Black people.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com