Health Disparities and Inequities

Research supported by the National Heart, Lung, and Blood Institute has helped people live longer, healthier lives. However, many groups experience poorer health than the overall population. Differences in health among population groups are called health disparities. Health disparities that are deemed unfair or stemming from some form of injustice are called health inequities. The NHLBI supports research to reduce health disparities and inequities in heart, lung, blood, and sleep disorders.

Research Making a Difference

Research Making a Difference

We’re only scratching the surface of what could be a treasure trove."
In the emerging world of personalized medicine, researchers are furiously looking for disease markers specific to minority populations, and already they have made some promising discoveries.
Group of people of different age and backgrounds.
WHY IT'S IMPORTANT

The Nation benefits when everyone has the opportunity to live a long, healthy, productive life. Despite the progress that has been made, many populations experience poorer health outcomes because of their race or ethnic group, religion, financial situation, education, sex, age, or because of where they live, such as in a rural area.

Many health concerns within the NHLBI portfolio, including heart disease, asthma, obesity, and diabetes, disproportionately affect certain populations. For example:

  • High blood pressure, a major risk factor for heart disease, is more common and not as well controlled in African American and Hispanic adults as in white adults.
  • In the United States, rural populations have higher rates of death due to heart disease, chronic lower respiratory disease, and stroke than urban populations.
  • Life expectancies vary by race and sex. For example, among females born in 2015, life expectancy is 84.3 for Hispanic females, 81.1 years for non-Hispanic white females, and 78.1 years for non-Hispanic African American females.
  • Children from low-income families are more likely to have asthma.
  • African Americans are almost three times more likely to die from asthma-related causes than white Americans.

The NHLBI is working to better understand the unique risk factors in different populations.

KEY ACCOMPLISHMENTS
  • A study linked residential segregation to higher blood pressure in African Americans, suggesting that policies to reduce segregation may have health benefits.
  • The Jackson Heart Study is the largest study of causes of cardiovascular disease in African Americans, involving more than 5,300 men and women.
  • The Strong Heart Study, the largest epidemiologic study of American Indians, examines cardiovascular disease and its risk factors in that population.
  • The Hispanic Community Health Study/Study of Latinos is the most comprehensive study of Hispanic/Latino health and disease in the United States.
  • The Multi-Ethnic Study of Atherosclerosis looks at early atherosclerosis in a diverse, population-based sample of more than 6,800 men and women.
OPPORTUNITIES & CHALLENGES

In 2016, the NHLBI released its Strategic Vision, which will guide the Institute’s research activities for the coming decade. Many of the objectives, compelling questions, and critical challenges identified in the plan focus on understanding the causes of population health differences and identifying strategies to address these differences. The NHLBI supports late-stage translational research to promote the rapid adoption and sustained use of proven-effective interventions to reduce and eliminate disparities in heart, lung, blood, and sleep disorders. Training the next generation of diverse scientists and clinicians to help address health disparities and inequities is also a high priority for the NHLBI.

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  • Supporting research in communities. The NHLBI continues to support research that includes patients, health care providers, policy makers, and their communities to learn how to better support the needs of these communities.
  • Partnering to conduct more research studies. The NHLBI will partner with other federal agencies and NIH institutes such as the National Institute of Minority Health and Health Disparities to support more research that can be used to reduce health disparities.
  • Improving care to populations with health disparities. The NHLBI is working to ensure evidence-based guidelines are adopted and implemented in health care settings to improve clinical care for all.
  • Addressing asthma disparities in children. The NHLBI is supporting clinical trials to evaluate asthma programs that provide comprehensive care for children at high risk of poor asthma outcomes. This includes children in rural areas.
  • Studying sleep deficiency and sleep disorders to reduce health disparities. Researchers are working to better understand disparities in sleep health and how they might be contributing to health disparities in other diseases, such as cardiovascular disease, obesity, and diabetes.

Advancing the Research

We Perform Research

NHLBI’s Division of Intramural Research (DIR) focuses on health disparities by using basic science findings to develop community-based approaches to help prevent obesity, heart attacks, and strokes in racially diverse populations. DIR researchers in Social Determinants of Obesity and Cardiovascular Risk Laboratory are exploring inequities among different populations.

We Fund Research

The research we fund today will help reduce the Nation’s health disparities and inequities. The NHLBI’s Center for Translation Research and Implementation Science (CTRIS) plans, fosters, and supports research to identify the best strategies to implement evidence-based interventions in the United States and abroad. CTRIS’s Health Inequities and Global Health Branch is the NHLBI’s main source for guidance on domestic and global health inequities implementation research. Other NHLBI Divisions also support research to address health disparities.

The Promise of Precision Medicine

Through NHLBI’s Trans-Omics for Precision Medicine (TOPMed) program, researchers will use data from studies focused on heart, lung, blood and sleep disorders to better predict, prevent, diagnose, and treat diseases based on a patient’s unique genes, environment, and molecular signatures, which can help address health disparities. Learn more about NHLBI precision medicine activities.

Improving the Heart Health of African Americans

The Jackson Heart Study is the largest investigation of causes of cardiovascular disease in African Americans, involving more than 5,300 men and women in Jackson, Mississippi. The goal of the study is to investigate genetic and environmental factors to understand how African Americans are disproportionately affected by cardiovascular diseases, especially high blood pressure, coronary heart disease, heart failure, stroke, and peripheral arterial disease.

Learning about the Health of American Indians

The Strong Heart Study is a study of cardiovascular disease and its risk factors among American Indian men and women and is one of the largest epidemiological studies of American Indians ever undertaken. The study has identified several risk factors that may account for the high rates of heart disease in the American Indian population, including having type 2 diabetes, high blood pressure, or high cholesterol, as well as engaging in smoking.

Identifying Strategies to Enhance Hispanic and Latino Health

The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is the most comprehensive study of Hispanic/Latino health and disease in the United States. The goals of the study are to describe the prevalence of selected chronic diseases, especially heart and lung conditions; the risk and protective factors associated with these conditions; and the relationship between the initial health profiles and future health events in a diverse cohort of Hispanics and Latinos.

Studying Diverse Populations to Prevent Cardiovascular Disease

The Multi-Ethnic Study of Atherosclerosis (MESA) is a medical research study that looks at early, or subclinical, atherosclerosis, a disease in which plaque builds up inside the arteries. Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death. MESA researchers study a diverse, population-based sample of more than 6,800 men and women who had no signs of cardiovascular disease at enrollment and were aged 45 to 84.

Reducing Asthma Disparities

The goals of the Consortium on Asthma among African-Ancestry Populations in the Americas (CAAPA) are to discover genes that confer asthma risk among individuals of African ancestry and to study genetic diversity in populations of African descent. Among people with asthma, people of African descent tend to have more severe asthma than people of European descent. The CAAPA project has sequenced over 1,000 genomes from a population of African-ancestry individuals living in North and South America, the Caribbean, and Africa.

Increasing the Diversity of Our Scientific Workforce

The Programs to Increase Diversity among Individuals Engaged in Health-Related Research (PRIDE) is an all-expense-paid Summer Institute that seeks to address new researchers’ difficulties in establishing academic research careers. The program seeks to increase the number of scientists from backgrounds currently underrepresented in the biomedical sciences and those with disabilities by preparing them to compete for research funding in heart, lung, blood, and sleep disorders.

Resources to Reduce Health Disparities

The Community Health Worker Health Disparities Initiative developed science-based, culturally appropriate health education materials and strategies to reduce health disparities in heart disease among underserved and minority communities. Available resources include manuals, DVDs, tip sheets, picture cards, and cookbooks for heart health.

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