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Invited Commentary
November 13, 2020

Disentangling Ancestry From Social Determinants of Health in Hypertension Disparities—An Important Step Forward

Author Affiliations
  • 1Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
  • 2Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
JAMA Cardiol. 2021;6(4):398-399. doi:10.1001/jamacardio.2020.6573

We are having difficult but necessary conversations about racial/ethnic health disparities in cardiovascular (CV) medicine. Instead of an implied assumption that racial/ethnic disparities in CV disease (CVD) morbidity and mortality are driven by inherently biologic differences across racial/ethnic groups, we are beginning to acknowledge as a medical and research community that race is what it has always been: a social construct. The disproportionate effects of the coronavirus disease 2019 pandemic, subsequent economic crisis, and police-sanctioned violence on Black people in the US have forced us to confront the definition of race. It is clear that systemic racism, or structural inequity defined by race, limits access to economic stability, quality health care, and safe, well-resourced environments, which are reflected in the social determinants of health for Black people in the US.1 There are important questions to tackle as clinicians and scientists begin to unravel the elements of race and structural racism that influence CV health. For instance, an important question is how and whether we should use race in predictive models defining clinical risk, such as the Get With the Guidelines–Heart Failure Risk Score for determining risk of in-hospital heart failure mortality or the Society of Thoracic Surgeons Short-term Risk Calculator for mortality risk in cardiothoracic surgery.2 Another fundamental question is how we can examine the association of ancestry with CVD outcomes, given that ancestry coexists but is not synonymous with race.

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