Neighborhood Factors, Individual Stressors, and Cardiovascular Health Among Black and White Adults in the US: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Associations Between Racial Residential Segregation and Hypertensive Disorders of Pregnancy among Black women: The Coronary Artery Risk Development in Young Adults Study

Introduction

Black women are at greater risk of hypertensive disorders of pregnancy (HDP). Racial residential segregation (RRS) drives racial health disparities. This study investigates the association between RRS and the onset of HDP among Black parous women in the U.S.

Methods

The Coronary Artery Risk Development in Young Adults study is a cohort of Black and White adults aged 18-30 from four U.S. cities, recruited in 1985 and followed for over 30 years. RRS was measured using the local Getis-Ord Gi∗ statistic, categorizing neighborhoods as high (Gi∗ >1.96), medium (Gi∗ 0-1.96), or low (Gi∗ <0). Among Black women with at least one post-baseline pregnancy, HDP was self-reported as gestational hypertension, preeclampsia, or eclampsia. Generalized mixed models determined the association between RRS and HDP, for pregnancies (n = 941) nested within Black women (n = 598), and adjusting for age, follow-up time, time to pregnancy, education, income, BMI, physical activity, smoking, hypertension, baseline parity, and cumulative pregnancies.

Results

The mean age was 23.1 years (SD: 3.6), with 22.7 % reporting HDP in at least one pregnancy. The cumulative incidence of HDP was 23.0 % in high, 20.6 % in medium, and 23.7 % in low RRS neighborhoods. Fully adjusted models showed no significant association between medium RRS (OR: 1.11; [95 % CI: 0.52, 2.40]) or low RRS (OR: 0.94; [95 % CI: 0.42, 2.16]) compared with high RRS and HDP.

Conclusions

RRS was not associated with HDP among Black women. Future research should consider multifaceted factors through which racial segregation may relate to maternal outcomes.

Neighborhood violence, hair cortisol, and perceived stress among Black men living in a large urban city

BACKGROUND

Exposure to social stress, such as neighborhood violence, affects the body's psychoneuroendocrinology, contributing to multiple chronic diseases. Hair cortisol concentration (HCC) is a novel proxy measure of chronic stress response. While Black Americans are exposed to social stress at a higher level, the association between violence exposure and HCC has not been extensively examined in older Black men. Intersectionality of race, gender, and class may disproportionately affect Black men to exposure to violence, thus, elevated HCC.

METHODS

Black men aged 45 and older were recruited from four barbershops in predominantly Black communities in Chicago. Hair samples were collected by barbers for HCC, and a set of survey questions concerning perceived stress, exposure to violence, and fear of crime were collected along with demographic characteristics and residential community area. Using the residential community area, the homicide and poverty rates were appended. Descriptive statistics and a two-level hierarchical regression were used to examine the association between HCC and individual- and neighborhood-level factors.

RESULTS

A total of 127 participants were included in the final analytic sample. The mean HCC was 22.3 pg/mg for those living in the lowest quartile homicide rates, while the mean HCC was 40.2 pg/mg for participants residing in the highest quartile homicide areas. Log-HCC was significantly correlated with homicide rate (r = .264, P < .01) and perceived violence exposure (r = .195, p = .028) but not with perceived stress (r = .100, p = .508) or fear of crime (r = .124, p = .136). Multilevel regression models showed that log-HCC was significantly higher for those living in the highest homicide quartile compared to HCC in the lowest quartile homicide rate (p < .01), controlling for age, being a current smoker, being married, being unemployed, and perceived stress, violence exposure, and fear of crime measures.

CONCLUSION

HCC was significantly higher for Black men residing in neighborhoods with high violence. The study highlights how Black men, particularly those in segregated urban areas, experience disproportionate exposure to social stressors such as neighborhood violence. The study findings demonstrate that multiple social positions compound exposure to systemic inequities, which results in elevated risk of mental and physical health conditions.

Prenatal Psychosocial Stressors and Blood Pressure Across 4 Years Postpartum

BACKGROUND

Psychosocial stress is a cardiovascular risk factor; however, little is known about whether prenatal psychosocial stressors influence postpartum cardiovascular health. We aimed to examine the associations of multiple measures of prenatal psychosocial stress on maternal blood pressure (BP) in the first 4 years after birth.

METHODS

Among 225 MADRES cohort (Maternal and Developmental Risks From Environmental and Social Stressors) participants, we examined associations of average prenatal Perceived Stress Scale (PSS), Center for Epidemiological Studies Depression (CES-D) scores, and second-trimester neighborhood social cohesion scores on systolic and diastolic BP collected at annual postpartum study visits (1-4 years) using linear mixed-effects models, adjusted for covariates.

RESULTS

Higher prenatal PSS and CES-D scores were associated with greater diastolic BP at 1 year postpartum (0.24 [95% CI, 0.01-0.46] and 0.24 [95% CI, 0.08-0.40] mm Hg per 1-unit higher PSS and CES-D, respectively) and greater systolic BP (0.25 [95% CI, 0.02-0.48] mm Hg per 1-unit higher CES-D). Overall associations of PSS and CES-D with BP were attenuated over the 4-year postpartum period (P<0.05). Stratified analyses suggested larger associations of PSS and CES-D among US-born participants and participants with normotensive pregnancies. While neighborhood social cohesion was not associated with postpartum BP overall, higher neighborhood social cohesion scores were associated with lower BP at 1 year postpartum among participants with normotensive pregnancies and lower systolic BP among foreign-born Hispanic participants.

CONCLUSIONS

Higher prenatal perceived stress and depressive symptoms were associated with greater 1-year postpartum BP, whereas neighborhood cohesion was associated with lower 1-year postpartum BP. These results suggest prenatal psychosocial factors may impact cardiovascular health within the first year after birth.

Trajectory of Cardiovascular Health Across Childhood and Adolescence

Importance

The American Heart Association put forth the Life's Essential 8 construct to assess cardiovascular health (CVH) based on 8 behavioral and health factors. Few studies have characterized the natural history of CVH in early life or identified its sociodemographic determinants.

Objective

To characterize CVH trajectories across childhood and adolescence and identify associations with sociodemographic variables.

Design, Setting, and Participants

This study used data from the Project Viva prebirth cohort, an ongoing prospective prebirth cohort study conducted in a large multispecialty group practice in eastern Massachusetts among women who were pregnant and enrolled from April 1999 to November 2002. Participant inclusion required 3 or more CVH metrics in early childhood (median [range] age, 3.2 [2.8-6.2] years) or 4 metrics or more in midchildhood (median [range] age, 7.7 [6.6-10.9] years), early adolescence (median [range] age, 13.0 [11.9-16.6] years), or late adolescence (median [range] age, 17.5 [15.4-20.1] years). Of 2218 live births in the original cohort, 1523 were included in the present analysis. Data were analyzed from June to December 2023.

Exposures

Child sex, race, and ethnicity; maternal education; and household income.

Main Outcomes and Measures

CVH score (0-100 points) from early childhood to late adolescence, calculated as the unweighted average of all available CVH metrics at each life stage.

Results

Among 1523 children, 782 (51.4%) were male; 53 (3.5%) were non-Hispanic Asian, 231 (15.2%) were non-Hispanic Black, 988 (65.0%) were non-Hispanic White, and 175 (11.5%) were non-Hispanic other. The mean (SD) CVH score was 82.6 (8.6) in early childhood, 84.1 (8.3) in midchildhood, 82.0 (9.8) in early adolescence, and 73.8 (11.5) in late adolescence. The estimated mean (SD) age of inflection when CVH score declined was 10.1 (0.7) years for male children and 10.0 (0.6) years for female children; the decline in CVH was associated with health behaviors rather than health factors. Male children (vs female children) had faster CVH score gain before the inflection (β, 0.79 points/year; 95% CI, 0.67 to 0.91) and faster CVH score decline after the inflection (β, -0.33 points/year; 95% CI, -0.44 to -0.22). Non-Hispanic Black children (β, 0.32 years; 95% CI, 0.20 to 0.43) and children of other non-Hispanic races (β, 0.16 years; 95% CI, 0.05 to 0.28) children had later timing of inflection compared with non-Hispanic White children. Children of mothers without (vs with) a college degree or with household income $70 000 per year or less (vs greater than $70 000/year) exhibited lower CVH trajectory throughout childhood. Children of mothers with some college education (vs a college degree) had later timing of inflection (β, 0.16 years; 95% CI, 0.07 to 0.26) and slower CVH score gain before the inflection (β, -0.24 points/year; 95% CI, -0.40 to -0.08).

Conclusions

This study provides insight into the trajectory of CVH early in life, which may contribute to CVH disparities in adulthood, and identified modifiable health behaviors for focused prevention efforts to optimize CVH in early life.

Space for improvement: ZIP codes should not determine cardiovascular longevity, a scoping review

Location-based disparities in cardiovascular health are multifaceted and deeply intertwined with historical, environmental, socioeconomic, and healthcare access factors. This scoping review explores the associations between residential locations and cardiovascular disease (CVD). We reviewed articles that describe environmental influences, socioeconomic determinants, healthcare access challenges, and societal influences in the location-specific development of CVD. We describe some of the social determinants within geographical and neighborhood-level contexts that drive CVD inequality and explore potential future directions for addressing these disparities.

Telemedicine Use and Hypertension Control in an Urban Community Health Center Cohort

BACKGROUND

Real-time or synchronous telemedicine can be a valuable adjunctive strategy for chronic disease management, but few studies have assessed its impact on hypertension control among safety-net populations.

OBJECTIVE

To evaluate whether telemedicine is associated with blood pressure (BP) control.

DESIGN

Retrospective cohort study. Mixed-effects logistic regression models clustered by the patient estimated associations between telemedicine and BP control after adjusting for patient factors and neighborhood context.

PARTICIPANTS

Patients seeking care at an urban, multisite community health center with hypertension and ≥1 BP measurement between 2020 and 2022 (3663 patient-year observations across 2086 unique patients).

MAIN MEASURES

The primary outcome was BP control defined as a binary variable. We used the Centers for Medicare & Medicaid Services' Controlling High Blood Pressure quality measure criteria of systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg in the most recent recording in the measurement year.

KEY RESULTS

Among the 2086 patients with hypertension in our sample, there were 1257 (60.3%) Latinx and 425 (20.4%) Black patients. Over 90% lived in a neighborhood of high deprivation as categorized by the social deprivation index. Telemedicine visits, compared to none, were not associated with blood pressure control (1-2 telemedicine visits aOR, 1.05 [95% CI, 0.86-1.28]; ≥3 telemedicine visits aOR, 0.86 [95% CI, 0.68-1.09]). One in-person visit per year, compared to 2-3, was associated with lower odds of BP control (aOR, 0.72 [95% CI, 0.55-0.94]). Black patients, compared to Latinx patients, were less likely of having BP control (aOR, 0.64 [95% CI, 0.48-0.87]).

CONCLUSIONS

In this community health center cohort of patients with hypertension, telemedicine did not compromise blood pressure control. Persistent racial disparities in blood pressure control underscore the need for equity-centered strategies for hypertension management in safety-net primary care settings.

A systematic review of the relationship between neighborhood stressors, discrimination, and cardiometabolic outcomes during pregnancy

Cardiometabolic outcomes during pregnancy, including hypertensive disorders of pregnancy (HDP) and gestational diabetes, disproportionately affect racial and/or ethnic minority groups in the United States. These disparities are not fully explained by traditional risk factors, but race-related psychosocial stressors such as perceived neighborhood stressors and discrimination (PNSD) may contribute to adverse health outcomes. This systematic review examined the literature on the impact of PNSD on HDP and gestational diabetes. A comprehensive search of PubMed, PsycINFO, Embase, Web of Science, and CINAHL identified 10 eligible studies: seven cohort and three cross-sectional studies. Five studies reported significant associations between PNSD and increased risk for cardiometabolic outcomes during pregnancy (HDP-1 study, gestational diabetes-3 studies, both hypertension and diabetes during pregnancy-1 study). The included studies demonstrated good methodological quality. These findings suggest that PNSD may be associated with cardiometabolic outcomes during pregnancy, but further research is needed, particularly on perceived neighborhood stressors.

The Role of Psychological Health in Cardiovascular Health: A Racial Comparison

Purpose: Modifiable health factors influence racial disparities in cardiovascular health (CVH), yet the role of psychological health in these disparities remains understudied. This study examines (1) the association between negative and positive psychological health measures and CVH and (2) the racial differences in these associations among US adults. Methods: Aim 1 included adults aged 34-84 from the MIDUS biomarker substudy (n = 1255). Aim 2 included adults aged 28-84 from the MIDUS parent study (N = 4702). Our outcome was CVH, operationalized as the AHA's Life's Essential 8 (LE8) total score, behavior, and health factor subscores. Negative psychological health was operationalized as depressive symptoms (CES-D), stress reactivity (from the Multidimensional Personality Questionnaire [MPS]), aggression (from the MPS), pessimism (Life Orientation Test), perceived stress (Perceived Stress Scale), and trait anxiety (Spielberger Trait Anxiety Inventory); positive psychological health was operationalized as psychological well-being ("PWB"; Ryff Well-Being Scale [WBS] and MPS), purpose in life (from the WBS), mindfulness (developed by MIDUS), gratitude (developed by MIDUS), and optimism (Life Orientation Test). Results: In covariate-adjusted models, most negative psychological health factors were negatively associated with LE8 total scores and health behavior subscores. Of those, pessimism was the only factor to demonstrate Black-White differences (Black > White, p < 0.001). Positive psychological health factors were less consistently associated with the LE8 total, health behavior, and health factor subscores in covariate-adjusted models. Of these, PWB (Black > White, p < 0.001), gratitude (Black > White, p < 0.001), and optimism (Black > White, p < 0.001) demonstrated significant differences by race. Conclusions: Black-White differences in LE8 are not largely explained by differences in psychological health.

Excess Mortality Rate in Black Children Since 1950 in the United States: A 70-Year Population-Based Study of Racial Inequalities

BACKGROUND

Black Americans have lower wealth, income, and education and higher mortality rates than White Americans, especially during childhood.

OBJECTIVE

To document the extent and persistence of excess infant and childhood mortality in Black Americans between 1950 and 2019.

DESIGN

Population-based surveillance study.

SETTING

The United States of America.

PATIENTS

The entire population of the United States.

MEASUREMENTS

The investigators analyzed mortality data collected by the Centers for Disease Control and Prevention and the U.S. Census Bureau from 1950 to 2019 and calculated mortality rates, life expectancy, and years of potential life lost for White and Black Americans to estimate the absolute and relative sex- and age-specific excess mortality burden among Black Americans compared with White Americans.

RESULTS

The gaps in absolute life expectancy and age-standardized mortality between Black and White Americans decreased over the 70-year period beginning in 1950, but relative mortality in infants and children increased during this same period. The mortality rates in the 1950s for White and Black infants were 2703 and 5181 deaths per 100 000 persons, respectively, for an excess mortality ratio of 1.92 (95% CI, 1.91 to 1.93). In the 2010s, the mortality rates were 499 deaths per 100 000 persons in White infants and 1073 deaths per 100 000 persons in Black infants, for an excess mortality ratio of 2.15 (CI, 2.13 to 2.17). A total of 5.0 million excess deaths of Black Americans (including 522 617 infants) could have been avoided during these 7 decades if their mortality rates were equal to those of White Americans.

LIMITATION

The effect of health inequities was measured without inquiring about the causes of these differences.

CONCLUSION

Black infants, children, and adults have experienced persistent excess mortality in the United States since the 1950s relative to the White population.

PRIMARY FUNDING SOURCE

None.

Social Inequities in Cardiovascular Disease Risk Factors at Multiple Levels Persist Among Mothers in Texas

The life stage between the ages of 30-45 years for women is critical, given the competing demands of occupational advancement, intimate partner relationships, and childcare responsibilities. Cardiovascular disease (CVD) is the leading cause of death among women in the US, which is experienced inequitably by race/ethnicity/nativity and socioeconomic status and is embedded within geographic contexts. The objective of the current study was to examine social inequities in pre-pregnancy risk factors for cardiovascular disease. We analyzed 16 years of geocoded natality data in Texas (N = 2,089,588 births between 2005 and 2020 to mothers aged 30-45 years) linked with census tract- and county-level data. Dependent variables included pre-pregnancy diabetes, hypertension, obesity, and smoking. Independent variables included individual-level race/ethnicity/nativity and educational attainment, tract-level poverty and racial/ethnic concentrations, and county-level urban/rural status, with controls for other sociodemographic characteristics and time trend. Two-level, random intercept hierarchical generalized logistic models were used to estimate associations and model fit. Significant social inequities at the individual-, tract-, and county-levels in each risk factor were found. For example, tract-level variables had substantial and significant association with the four CVD risk factors, ranging from 13% to 72% higher odds in adjusted models. For all four risk factors, the more rural the county of residence was, the higher the odds of having the risk factor (24% to 256% higher odds). Individual-level social inequalities by race/ethnicity/nativity (ORs ranging from 0.04 to 2.12) and education (ORs ranging from 1.25 to 5.20) were also observed. Enhancing our understanding of this important period of life may enable policy and interventions to better support women through this critical life stage.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Getting to the Heart of the Matter: Exploring the Intersection of Cardiovascular Disease, Sex and Race and How Exercise, and Gut Microbiota Influence these Relationships

Cardiovascular disease (CVD) is the leading cause of death worldwide, with physical inactivity being a known contributor to the global rates of CVD incidence. CVD incidence, however, is not uniform with recognized sex differences as well and racial and ethnic differences. Furthermore, gut microbiota have been associated with CVD, sex, and race/ethnicity. Researchers have begun to examine the interplay of these complicated yet interrelated topics. This review will present evidence that CVD (risk and development), and gut microbiota are distinct between the sexes and racial/ethnic groups, which appear to be influenced by acculturation, discrimination, stress, and lifestyle factors like exercise. Furthermore, this review will address the beneficial impacts of exercise on the cardiovascular system and will provide recommendations for future research in the field.

Intersectionality and Social Drivers of Health in Cardiovascular Care

Social drivers of health (SDOH) are a significant contributor to persistent cardiovascular health disparities in the United States and globally. SDOH include psychosocial, environmental, socioeconomic, cultural, and governmental factors that impact health behaviors and outcomes. Multiple social drivers have been associated with trends in cardiovascular disease risk and health outcomes. These social drivers intersect in complex ways, and applying the concept of intersectionality is critical when considering ways to best address SDOH in cardiovascular care. Applying intersectionality, which considers the unique combination of social drivers associated with a community, allows for tailored interventions to address cardiovascular health disparities.

Association Between Caregiver Strain and Self-Care Among Caregivers With Hypertension: Findings From the REGARDS Study

BACKGROUND

Self-care for adults with hypertension includes adherence to lifestyle behaviors and medication. For unpaid caregivers with hypertension, the burden of family caregiving may adversely impact self-care. We examined the association between caregiver strain and hypertension self-care among caregivers with hypertension.

METHODS AND RESULTS

We included participants of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study who identified as caregivers and had hypertension. Caregiver strain, assessed by self-report, was categorized as "none/some" or "high." Hypertension self-care was assessed individually across 5 domains (Dietary Approaches to Stop Hypertension [DASH] diet, physical activity, alcohol use, cigarette smoking, and medication adherence) and a composite self-care score summing performance across them. The association between caregiver strain and hypertension self-care was examined with multivariable linear regression. Among the 2128 caregivers with hypertension, 18.1% reported high caregiver strain. Caregivers with high strain versus those with none/some were less adherent to the DASH diet (50.8% versus 38.9%, P<0.002), physically inactive (44.4% versus 36.2%, P<0.009), current smokers (19.7% versus 13.9%, P<0.004), and had lower overall self-care scores (6.6 [SD 1.7] versus 7.0 [SD 1.7], P<0.001). In an age-adjusted model, high caregiver strain was associated with worse hypertension self-care (β=-0.37 [95% CI, -0.61 to -0.13]); this remained significant but was reduced in magnitude after adjustment for sociodemographics (β=-0.35 [-0.59 to -0.11]), comorbidities (β=-0.34 [-0.57 to -0.10]), caregiving intensity (β=-0.34 [-0.59 to 0.10]), and psychological factors (β=-0.26 [-0.51 to 0.00]).

CONCLUSIONS

High caregiver strain was associated with worse hypertension self-care overall and across individual domains. Increased awareness of caregiver strain and its potential impact on hypertension self-care is warranted.

Building the African American/Black Community's Capacity to Elucidate Factors for High Smoking Rates in Jackson, MS: Results from Implementing a Community-Led Needs Assessment

INTRODUCTION

Although smoking has decreased dramatically over the last 50 years, reductions are uneven by race and income, specifically in the Southern United States. There is a need for intentional collaboration with communities located where large tobacco disparities exist to make lasting change. Using community-based participatory research principles, we provided intensive capacity building to a community advisory group (CAG) of 14 Jackson, MS, residents to conduct a community-led needs assessment. The aim of the community-led needs assessment was to investigate firsthand why the community smokes and the impacts of smoking-giving the CAG voice and choice to work towards reducing tobacco-related harms and inequities.

METHODS

From October 2020 to September 2021, CAG members conducted thirteen interviews and nine focus groups, reaching 54 residents. We analyzed the data using a thematic and in vivo approach.

RESULTS

Participants reported smoking is used to cope with systemic socio-economic issues (e.g., racism, poverty). Smoking is normalized in the community through continued use, ease of purchase, visibility of tobacco retailers, and lack of conversations or questioning surrounding smoking. Participants felt that peer and family use, addiction, and inaccessible smoking resources were the most influential factors driving smoking behaviors.

CONCLUSION

This community engagement approach empowered residents to design and implement a comprehensive needs assessment resulting in rich data-a needed approach for a community experiencing enduring health inequities. Communities need to be engaged and invested in from the beginning as equal partners to learn, investigate, and develop community-relevant and innovative solutions to address tobacco social norms.

Impact of Poverty on Stroke Recurrence: A Population-Based Study

BACKGROUND AND OBJECTIVES

Poverty is associated with greater stroke incidence. The relationship between poverty and stroke recurrence is less clear.

METHODS

In this population-based study, incident strokes within the Greater Cincinnati/Northern Kentucky region were ascertained during the 2015 study period and followed up for recurrence until December 31, 2018. The primary exposure was neighborhood socioeconomic status (nSES), defined by the percentage of households below the federal poverty line in each census tract in 4 categories (≤5%, >5%-10%, >10%-25%, >25%). Poisson regression models provided recurrence rate estimates per 100,000 residents using population data from the 2015 5-year American Community Survey, adjusting for age, sex, and race. In a secondary analysis, Cox models allowed for the inclusion of vascular risk factors in the assessment of recurrence risk by nSES among those with incident stroke.

RESULTS

Of 2,125 patients with incident stroke, 245 had a recurrent stroke during the study period. Poorer nSES was associated with increased stroke recurrence, with rates of 12.5, 17.5, 25.4, and 29.9 per 100,000 in census tracts with ≤5%, >5%-10%, >10%-25%, and >25% below the poverty line, respectively (p < 0.01). The relative risk (95% CI) for recurrent stroke among Black vs White individuals was 2.54 (1.91-3.37) before adjusting for nSES, and 2.00 (1.47-2.74) after adjusting for nSES, a 35.1% decrease. In the secondary analysis, poorer nSES (HR 1.74, 95% CI 1.10-2.76 for lowest vs highest category) and Black race (HR 1.31, 95% CI 1.01-1.70) were both independently associated with recurrence risk, though neither retained significance after full adjustment. Age, diabetes, and left ventricular hypertrophy were associated with increased recurrence risk in fully adjusted models.

DISCUSSION

Residents of poorer neighborhoods had a dose-dependent increase in stroke recurrence risk, and neighborhood poverty accounted for approximately one-third of the excess risk among Black individuals. These results highlight the importance of poverty, race, and the intersection of the 2 as potent drivers of stroke recurrence.

Race-ethnicity and sex differences in 1-year survival following percutaneous coronary intervention among Medicare fee-for-service beneficiaries

RATIONALE

Existing literature describing differences in survival following percutaneous coronary intervention (PCI) by patient sex, race-ethnicity and the role of socioeconomic characteristics (SEC) is limited.

AIMS AND OBJECTIVES

Evaluate differences in 1-year survival after PCI by sex and race-ethnicity, and explore the contribution of SEC to observed differences.

METHODS

Using a 20% sample of Medicare claims data for beneficiaries aged 65+, we identified fee-for-service patients who received PCI from 2007 to 2015. We performed logistic regression to assess how sex and race-ethnicity relate to procedural indication, inpatient versus outpatient setting, and 1-year mortality. We evaluated whether these relationships are moderated by sequentially controlling for factors including age, comorbidities, presence of acute myocardial infarction (AMI), county SEC, medical resource availability and inpatient versus outpatient procedural status.

RESULTS

We identified 300,491 PCI procedures, of which 94,863 (31.6%) were outpatient. There was a significant transition to outpatient PCI during the study period, especially for men compared with women and White patients compared with Black patients. Black patients were 3.50 percentage points (p < 0.001) and women were 3.41 percentage points (p < 0.001) more likely than White and male patients to undergo PCI at the time of AMI, which typically occurs in the inpatient setting. Controlling for age and calendar year, Black patients were 2.87 percentage points more likely than non-Hispanic White patients to die within 1 year after PCI. After controlling for Black-White differences in comorbidities, the differences in 1-year mortality decreased to 0.95 percentage points, which then became nonsignificant when further controlling for county resources and state of residence.

CONCLUSION

Women were more likely to experience PCI in the setting of AMI and had less transition to outpatient care during the period. Black patients experienced higher 1-year mortality following PCI, which is explained by differences in baseline comorbidities, county medical resources, and state of residence.

Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases

High blood pressure causes over 10 million preventable deaths annually globally. Populations in low- and middle-income countries suffer the most, experiencing increased uncontrolled blood pressure and cardiovascular disease (CVD) deaths. Despite improvements in high-income countries, disparities persist, notably in the United States, where Black individuals face up to 4× higher CVD mortality than White individuals. Social determinants of health encompass complex, multidimensional factors linked to an individual's birthplace, upbringing, activities, residence, workplaces, socioeconomic and environmental structures, and significantly affect health outcomes, including hypertension and CVD. This review explored how social determinants of health drive disparities in hypertension and related CVD morbidity from a socioecological and life course perspective. We present evidence-based strategies, emphasizing interventions tailored to specific community needs and cross-sector collaboration to address health inequalities rooted in social factors, which are key elements toward achieving the United Nations' Sustainable Development Goal 3.4 for reducing premature CVD mortality by 30% by 2030.

Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States

Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.