Measuring the impact of a public health crisis in terms of mortality might seem a straightforward method to quantify its effect on the population because deaths are much more easily registered compared to other health outcomes. However, despite the intuitive appeal of this path, it is far from obvious how to best operationalize it, and all the most used methods have drawbacks that should be kept in mind. Especially during the COVID-19 pandemic, the major routes that have been considered are cause-specific death counts (and related measures such as case fatality rates), excess deaths estimates, and life expectancy decline. All the considered approaches have limitations: Cause-specific deaths are often subject to undercount or overcount issues with significant differences both between and within countries, excess deaths estimates may strongly depend on the baseline (there are several methods to estimate it), and life expectancy drop estimates (or estimates of years of life lost) also depend on the reference level used, which can vary substantially across countries. More generally, the issues of available data quality and standardization of age structure should be taken into proper account. Thus, the choice of which approach is worth using depends on the characteristics of the crisis that need to be evaluated and the type and quality of data available. Interestingly, the three approaches can also be combined so that some of their limitations can be mitigated.
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Psychosocial Aspects of Cardiovascular Disease in African Americans
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.
