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Reducing Ethnic Disparities Among Heart Disease Patients

In honor of American Heart Month, we highlight a study that shows how Kaiser Permanente Northern California dramatically reduced ethnic disparities in the risk of heart disease.

Mamie King is an active, African-American 80-year-old who walks daily and teaches line dancing three times a week. So when she woke up gasping for air one night, she assumed she was having an asthma attack.

Hours later, after a visit to the Emergency Department at Kaiser Permanente’s Oakland Medical Center, she got some surprising news. She had suffered a heart attack and required coronary stents to restore the blood flow to her heart.

Soon after her discharge, King began receiving personalized care as part of Kaiser Permanente’s MULTIFIT rehabilitation program. A nurse tests her blood periodically to measure her cholesterol and blood sugar, and she phones King regularly to make sure she is eating a heart-healthy diet and taking medications to control her blood pressure and cholesterol.

Moving Towards Colorblind Care

System-wide programs like this may be one factor that has allowed Kaiser Permanente Northern California to reduce or eliminate racial and ethnic disparities among its members in the risk of coronary heart disease (CHD). A recently completed study of 1.3 million members, with 10 years of follow up, found that blacks, Latinos, and Asians generally had lower risk of CHD than whites. That is in marked contrast to national statistics, where rates of CHD among blacks are nearly twice those of whites. The study appeared in the American Journal of Preventive Medicine.

Jamal S. Rana, MD, PhD

“Kaiser Permanente has been on the forefront in efforts to provide high-quality, systematic preventive care for members, both with and without existing heart disease, and that translates into equity of access,” said Jamal S. Rana, MD, PhD, a cardiologist at the Oakland Medical Center and a clinical adjunct with the Division of Research, who is the lead author of the study. “We strive to reach out to all of our members equally to keep them healthy.”

In addition to MULTIFIT, he cites the Preventing Heart Attacks and Strokes Everyday (PHASE) program, which draws on information in members’ electronic health records to provide coordinated interventions for people with CHD risk factors.

Mirroring the Region’s Diversity

Prior efforts to quantify racial differences in the risk of cardiovascular disease have focused exclusively on blacks and whites. “One of the strengths of our study is the inclusion of Latinos and Asians,” said Dr. Rana. “We have a diverse population in Northern California, and our study reflects that diversity.”

The study of 1.3 million members included approximately 190,000 Asians (14 percent) and 170,000 Latinos (13 percent), as well as 868,000 whites (64 percent) and 116,000 blacks (9 percent). The participants were men and women, ages 30 to 90, who were followed from 2002 through 2012.

Dr. Rana and his colleagues evaluated study subjects based on the presence or absence of existing CHD and diabetes. “These are the two biggest risk groups for future CHD,” he explained.

They learned that blacks, Latinos, and Asians without any prior history of CHD had lower risk of future CHD than whites, regardless of whether they also had diabetes.

Among members who had prior CHD but did not have diabetes, blacks had slightly increased risk of future CHD than whites. However, blacks with diabetes and prior CHD had the same chance of future CHD as whites in that risk group. Latinos did not have any difference in risk compared to whites in both these groups, and Asians had decreased risk.

Back on Her Feet

Three months after her heart attack, Mamie King is on the road to recovery. “I got excellent care, and I’m really pleased with the follow up I received through the MULTIFIT program,” she said.

Best of all, her cardiologist recently okayed her return to teaching dance. “I’ve been line dancing for 30 years, so it’s great to be back,” King said.

Hundreds of Kaiser Permanente members have been participating in a 30-year study through the Kaiser Permanente Division of Research that has led to important findings on health disparities and the prevention of cardiovascular disease. Watch a short video to learn more.