Racial Disparities in High Cholesterol Treatment in African Americans

Health disparities play a significant role in the type of care different populations or different groups of people receive based on demographics. These disparities lead to increased risk for injury and missed opportunities to receive optimal care in the healthcare system.

Racial disparities in hyperlipidemia treatment in African Americans contribute to heart disease, the number one cause of mortality in the United States of America. The African American non-Hispanic community has higher morbidity and mortality rates from cardiovascular disease than other racial groups. Per de Dios et al. (2020)¹, greater than 47% of African Americans have high cholesterol levels compared to less than 34% of Caucasians. This demographic has more missed visits and poor medication compliance in clinical practice. They are least likely to agree to medication treatment for high cholesterol, especially without comorbidities like diabetes and high blood pressure.     

Epidemiological Data

The Centers for Disease Control and Prevention (CDC) puts the prevalence of total cholesterol levels in non-Hispanic Blacks at 10.6% in men and 10.3 % in women (CDC, 2019)², which are second and third place, respectively, compared to other racial groups. Related morbidity and mortality rates are seen in cardiovascular and stroke-related deaths. According to (Cunningham et al., 2017)³, Blacks aged 35–49 "had higher death rates than Whites for heart disease...at ages 50–64 years, Blacks had higher death rates than Whites for leading chronic diseases.” This data supports the conclusion that African Americans are disproportionately affected by high cholesterol levels. So why does this population not receive equal treatment to other demographics?

Social Determinants of Health Involved

Social determinants of health contribute substantially to this health issue. Turnock (2022)⁴ defines social determinants of health as factors beyond an individual's biology that influence health. Examples are economic stability, neighborhood and physical environment, education, food availability, community and social context, and the healthcare system. Individuals and families residing in low-income areas are less likely to have access to good jobs, healthy foods, healthcare resources, and sound education systems. Several of their neighborhoods are ridden with crime and pollution, which negatively affects the physical, mental, and social well-being of those residing there. Unfortunately, even when healthcare is affordable and accessible, African American patients are often met with implicit biases from providers and other healthcare providers, further limiting access to quality healthcare.

The social determinants of health impacting hyperlipidemia treatment in Africa Americans are food, the healthcare system, community and social context, and economic stability. A population with poor access to healthy foods is more likely to consume fast food, which is cheaper but high in saturated fats. Unhealthy food equals unhealthy bodies. If people cannot afford healthcare or have poor access to quality healthcare, their health issues are left untreated, putting them at risk for morbidity and mortality. Community and social contexts like discrimination and related stressors rob people of appropriate treatment options. Lastly, those living in poverty cannot afford provider visits. This may not be a priority when day-to-day survival stares them in the face. For them, the risk of comorbidities and low-quality treatment options increases substantially and can result in adverse outcomes.

Relevance of This Issue

So why even discuss this issue? It is relevant to our communities because African Americans, and similar marginalized populations, are still facing challenges in hyperlipidemia treatment that can be solved. For our communities to be healthy, everyone must be given the resources to care for themselves. As nurses, we are empowered with solid voices to speak up for others, just like we advocate for our patients. Start at the bedside. Encourage your patients to get their cholesterol checked and follow up with a provider. Most providers can direct patients to available community resources to facilitate optimal care. Issues of justice, equality, and equity affect us all; our cumulative efforts in solving this care gap can make a difference.

Healthy communities equal a healthy nation.

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