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Amy L. Ai, Hoa B. Appel, and Sabrina L. Dickey

Cardiovascular disease (CVD) is the leading cause of death in the United States, but the burden of CVD falls disproportionately on racial and ethnic minority populations. Blacks are especially impacted by CVD. Since the 2010s, mortality from CVD has declined and life expectancy disparity between White and Black males has decreased. However, the mortality rate in Blacks remains the highest among all racial and ethnic groups. For example, concerning survival differences between White and Black patients with acute myocardial infarction, 5-year mortality for Black patients is significantly higher than that for White patients. Also, hypertension or high blood pressure and stroke, two of the most disabling diseases, burden Blacks much more than other groups. Furthermore, several major CVD comorbidities or risk factors are linked with disparity in Blacks, especially diabetes, obesity, and chronic kidney diseases. Physical inactivity is a major risk factor. Blacks and Hispanics, as well as Asian American women, all have higher rates of physical inactivity compared with Whites. The literature indicates the remarkable psychosocial and environmental issues that underlie CVD disparities in Black populations. Specifically, the social determinants of health (SDOH) have been shown to be significant indicators of CVD morbidity and mortality causing a disproportionate impact on racial and ethnic minorities and low socioeconomic status populations. These SDOH involving economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context provide a framework for a multifactorial approach to understand the impact of CVD on the Black community. The Black community has a history of trauma from racism and discrimination, which is still evident in the existence of structural racism. Trust in the health care system within the Black community remains an ongoing issue and stems from the unethical Tuskegee Study. The lack of trust in the U.S. health care system by the Black community is evident in the limited number of Black participants in research and the excess of health disparities within the Black community. Utilizing SDOH provides a context for understanding the complexity of addressing health disparities among historically marginalized groups. A unifactorial approach will not suffice when there are a number of physical, psychosocial, economic, and environment factors that adversely impact the health of underserved and underrepresented groups such as African Americans. Stringent policies to address racism, discrimination, and adequate access to health care for the Black community must be implemented to decrease the presence of CVD as a health disparity. Without the presence of a social and physical environment that provides adequate resources, such as health care services, quality education to attain employment and be health literate, employment to afford access to health care, and the support to engage in preventive care, African Americans will continue to suffer from various health disparities, such as CVD, and have shorter life spans compared to other racial and ethnic groups.