Racial Differences and Racial Disparities

Those who practice medicine in the United States are unavoidably confronted by the fact that health status, disease burden, and life span vary by population groups – particularly the persistent reality that cardiovascular disease outcomes are poorer in African Americans than in European Americans (the majority reference group), Asian Americans (those from China and Japan having best outcomes, those from South Asia having higher disease burden at younger ages), and Hispanic Americans (who experience better than expected outcomes despite having many risk factors). The causes for population variation in health outcomes are multifactorial and can include biological, environmental (physical and social), genetic, epigenetic, and social determinants, a mixture of disparities and differences.Article see p 882In this issue of Circulation , Kilic et al1 have examined clinical characteristics, biological features, and 1-year posttransplant mortality with the use of data from nearly 19 000 patients who have undergone orthotropic heart transplantation in the United States over a 10-year period. They compared clinical characteristics, immunologic features, and 1-year posttransplant outcomes among 3 US racial/ethnic groups designated as black (African American), white, and Hispanic. Significant differences were identified in 1-year posttransplant mortality and in several categories of variables that might impact posttransplant mortality, principally between African Americans and whites. Differences between whites and Hispanics were few. Variables included a few general social factors (highest level of education attained, insurance type); selected clinical features (renal function, time on the waiting list before transplant, etiology of heart failure, need for pretransplant mechanical support, donor and recipient risk scores, and posttransplant medication compliance); and a small number of biological features (degree of blood type and human leukocyte antigen matching, recipient sex, and donor recipient racial concordance).The key finding was a significantly higher adjusted and unadjusted 1-year posttransplant mortality for African Americans in comparison …