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The Racial Divide Within Our Heart ... Attacks

A new study finds racial disparities in survival rates, and they persist across class lines.
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(Photo: Sebastian Kaulitzki/Shutterstock)

(Photo: Sebastian Kaulitzki/Shutterstock)

Besides "driving while black," and the more recently coined "laughing while black," new research has revealed another activity people of color would be particularly wise to avoid: suffering a heart attack.

The American Heart Association journal Circulation published today the latest study revealing health disparities among Americans of different races. It finds that, in a large sample, white Americans lived an average of 6.4 years following a heart attack, while black patients lived an average of 5.6 years.

Unexpectedly, the gap was much higher at the upper end of the socioeconomic ladder than the lower one. Among Americans living in well-off neighborhoods, post-heart-attack life expectancy was seven years for whites, compared to 6.3 for blacks. Among those living in the poorest areas, racial differences in life expectancy were quite small: 5.6 years for white patients, and 5.4 for blacks.

"Because wealthy neighborhoods tend to have a greater concentration of white households, blacks living in these areas may experience less social cohesion and receive less support than those living in low-income areas."

"The implication here is that black patients and poor patients are disadvantaged—and higher socioeconomic status does not eliminate racial disparities," Harlan Krumholz of the Yale University School of Medicine said in a press statement accompanying the study, which he co-authored with his colleague Emily Bucholz. "[The results indicate] that blacks with greater resources remain vulnerable to poorer outcomes."

The researchers used data from the Cooperative Cardiovascular Project, which identified Medicare beneficiaries who were hospitalized after suffering acute myocardial infarction—a heart attack, in layman's terms—and tracked their progress for the following 17 years.

The researchers used a random sample of 141,095 such patients whose heart attacks occurred between January 1994 and February 1996, when they were between the ages of 65 and 90. Using zip code information, they categorized each as living in one of three types of neighborhood: high socioeconomic status (in the top 15th percentile of median household income), low socioeconomic status (one in the bottom 15th), or medium socioeconomic status (the rest).

Not surprisingly, they found black patients (who made up 6.7 percent of the total) were more likely to live in the poorer neighborhoods: 26 percent did so, compared to 5.7 percent of white patients. But the data suggests blacks who made it up the economic ladder did not get the same health boost as whites.

"After 17 years of follow-up, the survival rate was 7.4 percent for white patients and 5.7 percent for black patients," the researchers report. But this gap varied with the socioeconomic level of the patients' neighborhoods.

Among those in the wealthiest areas, 9.1 percent of whites survived after 17 years, compared to only  7.1 percent of blacks. In middle-income neighborhoods, the survival rates were seven percent for whites and 5.7 percent for blacks. The greatest amount of parity was found in the poorest neighborhoods, with a 5.4 percent survival rate for whites and 5.2 percent for blacks.

The reasons for this remain somewhat murky, although the researchers note that black patients in the study "had a higher prevalence of most cardiovascular risk factors, including diabetes, hypertension, congestive heart failure, and smoking."

Beyond that finding, they speculate that "because wealthy neighborhoods tend to have a greater concentration of white households, blacks living in these areas may experience less social cohesion and receive less support than those living in low-income areas."

The research team adds that "racial discrimination, whether perceived or actual, has been shown to increase cardiovascular disease risk and negatively impact health outcomes."

Indeed, a Northwestern University study released just last week reported the belief you are being discriminated against produces elevated levels of cortisol, a hormone associated with stress. This reaction, which has long-term negative health consequences, appears to be stronger among blacks.

So perhaps discrimination experienced during one's teen years, a particularly sensitive period in which stress can greatly impact a growing body, takes a toll much later in life. That's speculative, but it's an avenue worth pursuing. As Krumholz commented, "We have work to do to understand why blacks are disadvantaged, and immediately address it."

Findings is a daily column by Pacific Standard staff writer Tom Jacobs, who scours the psychological-research journals to discover new insights into human behavior, ranging from the origins of our political beliefs to the cultivation of creativity.