Social determinants of health exacerbate racial disparities in excess uncontrolled BP
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Key takeaways:
- Social determinants of health contribute to excess uncontrolled BP in Black adults compared with white adults.
- Structural interventions are necessary to prevent further disparities.
Social determinants of health contribute to excess levels of uncontrolled BP among Black adults compared with white adults taking antihypertensive medication, researchers reported.
“Many social determinants of health can be traced to laws and policies, some of which perpetuate long-standing structural racism that limits opportunities for educational, social and financial advancement,” Oluwasegun Philip Akinyelure, MD, MPH, of the department of epidemiology at University of Alabama at Birmingham, and colleagues wrote in Hypertension. “While the American Heart Association has recognized structural racism as the root cause for disparities in health and cardiovascular disease, addressing structural racism requires interventions at the individual, interpersonal and institutional levels.”
Data were derived from Akinyelure OP, et al. Hypertension. 2023;doi:10.1161/HYPERTENSIONAHA.122.20219.
To determine the impact of social determinants of health on the higher proportion of Black adults with uncontrolled BP, Akinyelure and colleagues evaluated data on 14,803 Black and white adults (mean age, 66.3 years; 42.9% men; 50.6% Black) aged 45 years or older taking antihypertensive medication from the REGARDS study that lasted from 2003 to 2007.
Researchers collected BP measurements from the REGARDS study and utilized the Healthy People 2030 framework for social determinants of health, which includes the following categories: education, economic, social context, neighborhood and health care.
Akinyelure and colleagues found that social determinants of health mediated the difference in excess uncontrolled BP in Black adults compared with white adults by 33% (95% CI, 22.1-46.8).
Furthermore, the social determinants of health that contributed most to excess levels of uncontrolled BP in Black adults compared with white adults were low annual household income (percent mediated, 15.8%; 95% CI, 10.8-22.8), low levels of education (percent mediated, 10.5%; 95% CI, 5.6-15.4), living in an area with a shortage of health care professionals (percent mediated, 10.4%; 95% CI, 6.5-14.7), living in a disadvantaged neighborhood (percent mediated, 11%; 95% CI, 4.4-18) and living in a high-poverty ZIP code (percent mediated, 9.7%; 95% CI, 3.8-15.5).
“Interventions addressing social determinants of health at the public policy, environmental, organizational and individual levels may improve BP control and reduce Black:white disparities in cardiovascular disease mortality,” the researchers wrote. “Future studies that use contemporary data, and assess a wider range of social determinants of health, including other individual level measures of access to care, would be needed to build on the current findings.”
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