Differences in CVD Risk Factors Among Black Ethnic Groups in America

Diana Baptiste, DNP, RN, CNE

New data from the American Heart Association’s EPI Scientific Sessions 2020 is shedding light on the differences in risk of cardiovascular disease (CVD) seen among populations of black people in the US—indicating major differences in risk between African Americans, African immigrants, and Afro-Caribbeans (AC).

While mountains of data have illustrated an increased risk of CVD among black individuals, the results of this comparative analysis highlight differences in risk factors among the 3 groups compared to their white counterparts and indicate race alone does not account for disparities seen in CVD risk factors.

"Prior research into heart disease racial disparities typically has studied only African Americans or has grouped U.S. and foreign-born blacks without considering ethnicity, birthplace or other factors," said lead investigator Diana Baptiste, DNP, RN, CNE, assistant professor at The Johns Hopkins University School of Nursing, in a statement. ”The study shows that race alone doesn't account for risk factor differences between blacks and whites.”

With so few studies examining the risk for CVD among groups of black individuals in America based on their ethnic backgrounds, Baptiste and a team of colleagues conducted a comparative analysis of individuals from the National Health Interview Survey from 2010 through 2018. From the survey, investigators identified 452,997 individuals, including 82,835 non-Hispanic blacks and 370,362 white individuals.

From the survey, investigators had multiple pieces of patient-related information including sociodemographic data and trends in self-reported CVD risk factors, including hypertension, diabetes, obesity, and smoking. To obtain predictive probabilities of the CVD risk factors in each group, investigators used generalized linear models with a Poisson distribution.

Of the 82,835 non-Hispanic blacks included in the study, 89% were African Americans, 5% were African immigrants, and 6% were Afro-Caribbeans. African immigrants were the youngest group—with a mean age of 40.8 years&mdash;but were also the least likely to be insured with just 76% being insured compared to 91% among whites and 83% among African Americans (P <.001). Furthermore, Afro-Caribbeans (23%) were more likely to have a college education compared to African Americans, but African immigrants (36%) were the only group with a greater likelihood than whites (32%) (P <.001).

Results of the investigators’ comparison indicated African immigrants had the lowest age- and sex-adjusted prevalence of hypertension, diabetes, obesity, and smoking. Investigators noted African Americans had a higher prevalence than all other groups for obesity and hypertension. Afro-Caribbeans had the highest prevalence of diabetes at 19%.

Additionally, analyses revealed smoking prevalence decreased significantly from 2010-2018 (P <.001). Conversely, the rates of overweight/obesity and diabetes increased in African Americans and whites during the study period (P <.001).

"Cultural and genetic influences, along with social factors such as wealth and employment, marital status, how people are educated and where they live and work, can affect risk and how it is managed, and ultimately health outcomes,” Baptiste said.

This study, “Heterogeneity in Cardiovascular Disease Risk Factor Prevalence Among Whites, African Americans, African Immigrants and Afro-Caribbeans: Insights From the 2010-2018 National Health Interview Survey,” was presented at EPI Scientific Sessions 2020.