SOCIAL, SEXUAL AND RACIAL FACTORS IMPACT RISK FOR HEART DISEASE
by Redford B. Williams, Ph.D.
People who don't have good social relations and/or have incomes near the poverty level are at a much greater risk for developing heart problems and dying much earlier than their natural lifespan, say researchers. A cardiac patient's race and sex also seem to determine whether certain life-saving procedures will be performed. This research on cardiovascular disease risk and prevention will be presented at the conference, Public Health in the 21st Century: Behavioral and Social Science Contributions in Atlanta, May 9 at 1:30pm at the Marriott Marquis.
In the first presentation, "The Role of Social Relations in Cardiovascular Disease Prevention," Dr. Redford B. Williams examines why people without good social relations are at an increased risk for developing cardiovascular disease and have recurrent heart problems once the disease already exists.
In a study of 1,368 patients with coronary disease at Duke University, Dr. Williams found that 50 percent of the patients who reported feeling very isolated were not married and had no one in whom they could confide died within five years. During the same time span, only 17 percent of those with either a spouse or confidant died. "These higher death rates among socially isolated heart patients could not be explained by any differences in the severity of the underlying heart disease," said Dr. Williams.
Much of the current research shows that those who harbor too much hostility -- a general mistrust, frequent angry feelings and aggressive behavior -- and those who suffer from depression have a lot more trouble initiating and maintaining social relations. "Hostility drives people away and depression keeps a person from wanting any social interactions," says Dr. Williams. "Also, having a job that places a high demand on producing a product or service with very little decision-making power has also been found to further fuel hostility, depression and social isolation. These four factors can definitely increase one's risk for cardiovascular disease," he said.
"Add some stress to this picture and you end up with a person with increased adrenaline, cortisol and blood pressure levels and an overwhelming desire to fight off the stressors. It can also lead to more smoking and alcohol use to relieve the feelings of stress," said Dr. Williams.
"The news is not all bad," said Dr. Williams. "Clinical trials research has shown that interventions that provide social supports directly or training in anger management and communication skills that enhance a patient's ability to obtain social support lead to improved prognosis in heart patients."
"And laboratory research shows cardiovascular responses to acute mental stressors can be reduced when social support is provided to the experimental subjects," concluded Dr. Williams. "People need to realize that they do need each other to stay healthy."
The second presentation, "Socioeconomic Factors and the Behavioral Epidemiology of Cardiovascular Disease," shows that adult health behaviors are also influenced by a person's socioeconomic status from childhood to adolescence to adulthood. Poverty in childhood has long-term negative health effects," said epidemiologist John Lynch, Ph.D., M.P.H., of the University of Michigan.
The more times a person experienced episodes of economic hardship, the greater their risk for developing serious difficulties with physical, psychological and cognitive functioning, according to a 29-year study of 1,000 adults. This study, conducted by Dr. Lynch, George Kaplan, Ph.D., and Sarah Shema of the University of Michigan, examined adults from Alameda County, California who were classified according to the number of times they experienced economic hardship between 1965 and 1983.
Economic hardship was defined as having a household income of less than twice the poverty line. These adults were examined in 1965, 1974 and in 1983 on income and health factors. Then in 1994, their physical, psychological, social and cognitive functioning were examined.
The more times people were in economic hardship between 1965 and 1983, the worse their health and functioning was in 1994. Compared with men and women who never experienced any economic hardship, those who had incomes less than 200 percent of the poverty line paid the consequences. Those who experienced bad financial times two or three times in 1965, 1974 or 1983 were 2.3 to 4.6 times more likely to report cognitive difficulties, 2.0 to 3.8 times more likely to be suffering physical health problems and 1.7 to 3.2 times more likely to suffer from depression in 1994.
But future employment patterns can make a difference in a person's health. In the Kuopio Ischemic Heart Disease Risk Factor Study of 2,682 middle-aged men from Finland, which looked at income and health behaviors and cardiovascular disease, Dr. Lynch found that low socioeconomic status led to poor health behaviors which increased the risk for disease. "However, those who were born into poor families but who completed their high school education and went on to find white-collar employment had better health behaviors. They did not smoke or drink as much as someone from a poor background who did not complete high school and went on to find employment in manual blue-collar occupations," said Dr. Lynch.
Those who remained economically disadvantaged over their entire lifecourse also had decreased levels of physical activity, ate more fatty and high- sodium foods and had higher levels of depression, hopelessness and cynicism as adults.
The third presentation, "Differential Utilization of Health Care Procedures as a Function of Race," examined the National Hospital Discharge Survey (NHDS) between 1988 and 1990 and found that "invasive cardiac procedures such as cardiac catherization, percutaneous transluminal coronary angioplasty (PTCA) and coronary bypass surgery (CABS) were being used less on Black patients than on White patients and less on females than on males," said Wayne H. Giles, M.D. of the Centers for Disease Control.
Among 10,348 persons hospitalized for acute myocardial infarction, White men received these procedures the most, followed by White women, Black men and Black women. Age, in-hospital deaths, health insurance and hospital transfer rates were ruled out as influences to the rates of receiving these cardiac procedures. "It is very clear from our findings that a person's race and sex greatly influenced the type of care given. The medical community needs to examine this further," concluded Dr. Giles.
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