Abstract
Cardiovascular disparities remain pervasive in the United States. Unequal disease burden is evident among population groups based on sex, race, ethnicity, socioeconomic status, educational attainment, nativity, or geography. Despite the significant declines in cardiovascular disease mortality rates in all demographic groups during the last 50 years, large disparities remain by sex, race, ethnicity, and geography. Recent data from modeling studies, linked micromap plots, and small-Area analyses also demonstrate prominent variation in cardiovascular disease mortality rates across states and counties, with an especially high disease burden in the southeastern United States and Appalachia. Despite these continued disparities, few large-scale intervention studies have been conducted in these high-burden populations to examine the feasibility of reducing or eliminating cardiovascular disparities. To address this challenge, on June 22 and 23, 2017, the National Heart, Lung, and Blood Institute convened experts from a broad range of biomedical, behavioral, environmental, implementation, and social science backgrounds to summarize the current state of knowledge of cardiovascular disease disparities and propose intervention strategies aligned with the National Heart, Lung, and Blood Institute mission. This report presents the themes, challenges, opportunities, available resources, and recommended actions discussed at the workshop.
| Original language | English |
|---|---|
| Pages (from-to) | 213-230 |
| Number of pages | 18 |
| Journal | Circulation Research |
| Volume | 122 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jan 2018 |
Bibliographical note
Publisher Copyright:© 2018 American Heart Association, Inc.
Funding
Although the focus of this workshop was on CVD disparities, participants recognized the substantial extent to which the social determinants of CVD disparities are shared with other health conditions. This reality underscores the potential synergy to be gained through wide collaboration. Several institutes, centers, and offices at NIH have resources and programs that can be invaluable in the effort to reduce and eliminate CVD disparities. For example, NIMHD supports a research framework that incorporates multiple health determinants during the life course.123 Based on the fundamental pillars of race/ethnicity and SES, NIMHD supports research that explores how biology, behavior, the built environment, culture and community, and the role of the healthcare system influence health outcomes. Understanding the importance of community-driven interventions can inform CVD disparities research. NIMHD and NHLBI support several research activities involving community health workers, the use of mobile technology in risk reduction, and CBPR that utilizes a health behavior intervention to increase community recognition of heart diseases and stroke warning signs and follow-up instructions engaging healthcare professionals. Insights gained from these research activities can be leveraged in planning CBPR for reducing and eliminating CVD disparities. The workshop participants encouraged NHLBI to consider collaborating actively with NIMHD and other NIH institutes, centers, and offices to address research gaps in understanding health disparities and implementation research to reduce CVD disparities. For example, how might enhancing access to healthcare services like portals for patients, e-referrals, and telemedicine reduce cardiovascular disparities? Insights and lessons learned from several NIMHD funding opportunity announcements124 may be invaluable to NHLBI because it charts the future for health disparities research as part of its strategic vision. The Prevention Research Centers (www.cdc.gov/PRC) provide a unique opportunity for NHLBI, CDC, and foundations to support CBPR focused on the elimination of cardiovascular disparities. The Prevention Research Centers constitute a network of 26 schools of public health and schools of medicine with preventive medicine residency programs that focus on community-based applied public health research. This research includes both investigator-initiated and sponsored research that could be supported by CDC, NIH, or a private foundation. Groups of Prevention Research Centers have come together in a series of thematic networks in the areas of cancer prevention, obesity, physical activity and nutrition, epilepsy, workplace health promotion, and healthy aging. However, there is not a specific thematic network focused on the elimination of cardiovascular disparities. Bringing together a robust group of researchers to collectively develop and implement such a research agenda could be particularly fruitful. In addition, the Agency for Healthcare Research and Quality practice-based research networks provide yet another important framework that could be used to support community-based multisector research with a strong grounding in active community engagement and community empowerment. Increased costs for funding both research and community-engagement activities Research and training infrastructure, such as the National Research Mentoring Network, provides evidence-based mentor training and mentee career development to diversify biomedical research.115 Short-term training programs, modeled after the NHLBI and Office of Behavioral and Social Sciences Research–supported Annual Summer Institute on Randomized Behavioral Clinical Trials116 and the NIH-supported Training Institute in Dissemination and Implementation Research in Health,117 may help stimulate interest in further training and launch careers. However, more intensive and extended training will likely be necessary to build skills, especially those related to community engagement. Two such programs are currently funded in dissemination and implementation research but are not supported by NHLBI. They include the Implementation Research Institute, funded by the National Institute of Mental Health, National Institute on Drug Abuse, and the Department of Veterans Affairs, and the Mentored Training in Dissemination and Implementation Research in Cancer, funded by the National Cancer Institute, the Department of Veterans Affairs, and the Cancer Research Network. Both Training Institute in Dissemination and Implementation Research in Health and the Implementation Research Institute training programs have been shown to increase dissemination and implementation grant submissions and success in obtaining funding.117,118 Unfortunately, available slots in these dissemination and implementation training programs are insufficient to meet demand within the scientific and practitioner community.119 Schools of Public Health may be especially well positioned to provide the required combination of didactic and experiential training. Other opportunities and resources that could be leveraged to support training and career development in advancing implementation research for the elimination of health disparities recommended for NHLBI consideration are shown in Table 7.
| Funders | Funder number |
|---|---|
| Community Leadership Institute of Kentucky | |
| Minority Serving Institution | |
| PRIDE Inc | |
| National Institutes of Health (NIH) | |
| National Institute of Mental Health | |
| National Institute on Drug Abuse | P30DA027828 |
| National Institute on Drug Abuse | |
| Centers for Disease Control and Prevention | |
| National Heart, Lung, and Blood Institute (NHLBI) | |
| National Childhood Cancer Registry – National Cancer Institute | |
| National Institute of Diabetes and Digestive and Kidney Diseases | |
| U.S. Department of Veterans Affairs | |
| Robert Wood Johnson Foundation | |
| CURE Childhood Cancer | |
| National Institute on Minority Health and Health Disparities (NIMHD) | |
| University of California San Francisco | |
| University of Minnesota, Minnesota Supercomputing Institute |
Keywords
- Cardiovascular diseases
- Community-based participatory research
- Geography
- Social class
- Social determinants of health
ASJC Scopus subject areas
- Physiology
- Cardiology and Cardiovascular Medicine
