By Laurence O. Watkins, M.D.
A professor at Harvard University would often ask his students, “When you meet a new patient, what is the one test that you could do that would tell you how long that patient is likely to live?” The typical student response was usually to ask about cigarette smoking or blood sugar levels. The professor’s response: “Just look at the color of his or her skin.”
In the United States, members of ethnic and racial minorities, especially African-Americans, have higher rates of death from heart attacks, strokes, heart failure and kidney failure than the majority white population. They also have higher rates of death from various cancers (the other major killer), as well as higher rates of infant mortality and deaths from homicide, suicide, and accidents.
Is skin color, race, or ethnicity a cause of diseases of the heart and blood vessels?
Not directly. The major causes of diseases of the heart and blood vessels are high blood pressure (or hypertension), elevated levels of cholesterol in the blood, cigarette smoking and diabetes. The higher rates of diseases of the heart and blood vessels observed in African-Americans are associated with a higher frequency of high blood pressure and diabetes, causes of the damage to the heart, blood vessels, and kidneys that result in death. However, it is also true that African-Americans with high blood pressure and diabetes are less likely to receive early and sustained medical care. When they do receive medical care, they actually receive worse care due to discrimination in the health care system. In other countries, such as the United Kingdom, where all citizens have equal access to medical care, citizens of African ancestry are no more likely to have legs amputated for the vascular disease caused by diabetes than are white citizens. In the U.S., the amputation rate is 2-3 times higher for African-American than whites.
Much of the difference in the frequency of risk factors and the risky behaviors that contribute to higher risk for African-Americans is related to lower levels of education, social and economic status, the ability to buy healthy foods, and to obtain medical care that would protect against early death. Those with less than 12 years of education (high school graduation) are more likely to have one or more of these risk factors: high blood pressure, high blood cholesterol, cigarette smoking and diabetes. They are also less likely to engage in regular physical activity.
Latinos now make up 15 percent of the U.S. population and are likely to make up more than 30 percent by the year 2050. Currently, the majority of Latinos are of Mexican origin (64 percent) with smaller contributions from Puerto Ricans (9 percent) and Cubans (3.4 percent). A particular problem among Latinos is diabetes mellitus, which is twice as frequent as in whites, 9.8 percent compared to five percent; which is related partly to diet and obesity. Awareness of high blood pressure among those who have it, the frequency of treatment and adequate control, are also lower among Latinos than among African-Americans and Non-Hispanic whites. Abnormal cholesterol profiles are also much more frequent among Hispanics.
Biological factors and lifestyle factors that contribute to higher rates of high blood pressure in African-Americans include lower potassium intake from fruits and vegetables, and weight gain. Among Latinos, especially those of Mexican origin, and among African-Americans, weight gain and obesity lead to the development of diabetes in adults, and in recent years, even in children.
What’s the solution?
Reducing the impact of risk factors on premature death from cardiovascular disease among Latnos and African-Americans will require a combination of approaches.
For African-Americans, it will require attempts to improve control of blood pressure, to bring about smoking cessation, and to hinder the rapid increase in obesity and diabetes by bringing about dietary change and increasing physical activity. Among Latnos, it will require increased outreach and education across language and cultural barriers to change the lifestyles that contribute to obesity and diabetes, and to ensure adequate care to control blood sugar and blood pressure levels.
The Harvard professor’s insight is correct. In the U.S., darker skin color identifies racial and ethnic groups at higher risk of early death. However, these factors do so in ways that are not determined primarily by genetic influences, but by the environment and the political culture in which we live. They are susceptible to change. Increased mortality does not have to be linked to skin color, race and ethnicity.
Dr. Laurence O. Watkins is a member of Close the Gap, a campaign to increase awareness of heart disease by minorities.