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Ann Thorac Surg 2003;76:S1348-S1355
© 2003 The Society of Thoracic Surgeons

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Supplement: understanding disparities in cardiovascular and thoracic surgical outcomes in African-Americans

Historical perspectives on the care of african americans with cardiovascular disease

^a Division of Cardiothoracic SurgeryLos Angeles, CA, USA
^b Research Centers in Minority Institutions, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA

^* Address reprint requests to Dr Scott, Charles R. Drew University of Medicine and Science, 12021 S. Wilmington Avenue, Los Angeles, CA 90059, USA
e-mail: roscott@cdrewu.edu

Presented at the symposium on Understanding Disparities in Cardiovascular and Thoracic Surgical Outcomes in African Americans, San Diego, CA, Jan 30, 2003.

The first 300 words of the full text of this article appear below.

	Introduction

 
Advances in medicine and surgery over the last 100 years have resulted in improved treatments for all forms of disease. Unfortunately, African Americans have not benefited equally when compared with Whites. African Americans have had an overall death rate that is 1.6 times higher than that of the White population. When the age-adjusted death rates for the ten leading causes of death in the United States in 1950 and 1995 are compared, the mortality rates have declined. However, among African Americans the mortality rates for cancer, diabetes, suicide, cirrhosis of the liver, and homicide were actually higher in 1995 than in 1950. When heart disease, the leading cause of death, is considered, there have been important reductions in mortality for the entire population during the past 50 years. However, the racial gap between African Americans and Whites is actually wider today than it was in 1950. The African American/White ratio of age-adjusted mortality rates for heart disease was 1.26 in 1950 and 1.58 in 1995 [1].

Although socioeconomic status has been posited as a major contributor to these observed differences [2], there is strong evidence that racial/ethnic health disparities persist at every socioeconomic level. Williams proposes that these differences reflect the impact of the social environment and the cumulation of adversity across multiple domains. These differences in health and their persistence through time reflect, in large part, policies and practices that are linked to the historic legacy of racism and that have created living conditions that are pathogenic for non-White populations [1]. The Institute of Medicine's landmark report from the Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care adds additional evidence. The Committee found that "disparities are consistent and extensive across a range of medical conditions... and occur independently of insurance status, income, . . . [Full Text of this Article]