What do race and ethnicity mean?
The terms “race” and “ethnicity” can both be used to refer to people of similar cultural, religious, tribal, or geographic ancestry, yet they are both notoriously difficult to define. Scientists have called for using other forms of classification that are more strongly based in biology.1, 2 Despite these troubled terms, health disparities exist along the blurry lines of “racial” or “ethnic” groups.3, 4
One of the difficulties of tracking health differences by race is that racial groups are defined in many different ways. The American Heart Association defines Latinos and Hispanics as persons who trace their ancestry to Spain, the Spanish-speaking countries of Central or South America, the Dominican Republic, or other Spanish-speaking cultures. It does not include people from Brazil, Guyana, Suriname, Trinidad, Belize, and Portugal. Many American studies limit their Hispanic population to Mexican Americans.5
White or Caucasian people are considered to be those of European descent but often there is no distinction made between Eastern and Western European descent. The term “Asian” may or may not incorporate those in Southeast Asia, the Pacific Islands, and those in Western Asian and the Middle East. South Asian is sometimes used to refer to people from India, Pakistan, or Bangladesh.
The government recommends using, at a minimum, the following classification system for race6:
- American Indian or Alaska Native
- Black or African American
- Hispanic or Latino
- Native Hawaiian or Other Pacific Islander
Should I tell my doctor about my racial or ethnic background?
Yes. Telling your doctor about your racial and ethnic background will help him or her better estimate your heart disease risk. Visual clues such as facial features or skin color have only a slim correlation with our race,7 so it is more helpful to tell your doctor where your ancestors are from than to have the doctor guess if you belong to some broad category such as black, white, or Asian.2 It is also important to let your doctor know how long you and your family have been living in the US because where you live now can sometimes reveal more about your health risks than your racial or ethnic background. For example, a study of Japanese and Japanese Americans living in Hawaii found that Japanese Americans had higher total cholesterol, a greater incidence of diabetes, and had more fatty plaque in their arteries than their counterparts still living in Japan.8,9
How can race or ethnicity influence my heart health?
Your Race & Ethnicity Can affect your health in two main ways:
Race and ethnicity can have an influence on a person’s environment, which includes many factors such as education level, access to healthcare, cultural practices, socioeconomic status, and stress level. Race is often closely related to a person’s socioeconomic status or how much money they make. Lower socioeconomic status is associated with an increase of chronic stress, which may lead to heart problems.10 Lower socioeconomic status is also linked to a diet high in saturated fat, cholesterol, and carbohydrates,11 as well as to poorer healthcare and health insurance.
Awareness of heart disease is lower in minority populations. In an all-women 2003 study, less than one third of African-American and Hispanic women correctly cited heart disease as the leading cause of death among women compared with more than half of white women surveyed.12 This survey also showed that black women, in particular, were less aware that smoking, high cholesterol, and family history increased their risk of heart disease. Some studies suggest that these social and economic factors are responsible for all of the racial/ethnic health differences or disparities.13
The second way that race and ethnicity can affect your heart health is through your genes. People of similar geographic ancestry share similar mutations in their genes.4 Some of these genetic variations have been linked to a higher risk of heart disease,3, 14, 15 but there are no routinely used genetic tests to see if a person carries one of these mutations. There is also no evidence that a person should receive different medical care because of their race. A report released by the Institute of Medicine that reviewed well over 100 studies on health disparities including heart disease, found that even after considering social and economic factors, racial and ethnic disparities remained.16 This study concluded that biases and prejudices among healthcare providers may be causing these disparities. However, some scientists believe that there may be a biological reason for health disparities.
How common is heart disease in different racial or ethnic groups?
Diseases of the heart and stroke are the leading cause of death in every ethnic group studied (white, black, Asian, Hispanic, and Native American) in the US.17 Death from heart disease or stroke at all ages is highest in African Americans.18 Black women are one third more likely to die from heart disease or stroke than white women.19
In 2001, early deaths (younger than 65 years) from heart disease were most common in Native American and Alaskan Native (36%) and African Americans (32%). They were lowest among whites (15%).20 In a study of more than 2,600 women, black women had a 52% higher risk of heart disease than white women after ruling out many other possible explanations such as weight, blood pressure, and smoking.21
Hospitalization rates for heart disease vary between Asian people of different geographic ancestry. When compared with white people, Chinese people are less likely to be hospitalized with heart disease, Japanese and Filipinos are as likely, and South Asians (Indian) are more likely.22
There are racial and ethnic differences in heart disease and stroke as well.