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Cardiac risk underestimation in urban, black women

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Abstract

BACKGROUND: Black women have a disproportionately higher incidence of cardiovascular disease mortality than other groups and the reason for this health disparity is incompletely understood. Underestimation of personal cardiac risk may play a role.

OBJECTIVE: We investigated the personal characteristics associated with underestimating cardiovascular disease in black women.

DESIGN, SETTING, PARTICIPANTS: Trained surveyors interviewed 128 black women during the baseline evaluation for a randomized controlled trial in an urban, academic continuity clinic affiliated with a public hospital system. They provided information on the presence of cardiac risk factors and demographic and psychosocial characteristics. These self-report data were supplemented with medical record abstraction for weight.

MEASUREMENTS AND MAIN RESULTS: The main outcome measure was the accurate perception of cardiac risk. Objective risk was determined by a simple count of major cardiac risk factors and perceived risk by respondent’s answer to a survey question about personal cardiac risk. The burden of cardiac risk factors was high in this population: 77% were obese; 72% had hypertension; 48% had high cholesterol; 49% had a family history of heart disease; 31% had diabetes, and 22% currently used tobacco. Seventy-nine percent had 3 or more cardiac risk factors. Among those with 3 or more risk factors (“high risk”), 63% did not perceive themselves to be at risk for heart disease. Among all patients, objective and perceived cardiac risk was poorly correlated (κ=0.026). In a multivariable model, increased perceived personal stress and lower income were significant correlates of underestimating cardiac risk.

CONCLUSIONS: Urban, disadvantaged black women in this study had many cardiac risk factors, yet routinely underestimated their risk of heart disease. We found that the strongest correlates of underestimation were perceived stress and lower personal income.

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Authors and Affiliations

  1. Department of Medicine, Section of General Internal Medicine and Geriatrics, Tulane University Health Sciences Center, New Orleans, La, USA

    Karen B. DeSalvo MD, MPH, MSc, Jessica Gregg MD, PhD, Bonnie R. Pedersen MPH & Alayna Stepter BS

  2. Department of Medicine, Section of Nephrology, Tulane University Health Sciences Center, New Orleans, La, USA

    Myra Kleinpeter MD, MPH

  3. Institute for Global Health and San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, Calif, USA

    John Peabody MD, DTM&H, PhD, FACP

  4. Amgen, Thousand Oaks, Calif, USA

    John Peabody MD, DTM&H, PhD, FACP

Authors
  1. Karen B. DeSalvo MD, MPH, MSc
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  2. Jessica Gregg MD, PhD
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  3. Myra Kleinpeter MD, MPH
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  4. Bonnie R. Pedersen MPH
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  5. Alayna Stepter BS
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  6. John Peabody MD, DTM&H, PhD, FACP
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Corresponding author

Correspondence to Karen B. DeSalvo MD, MPH, MSc.

Additional information

The authors have no conflict of interest to declare for this article or this research.

This study was supported by a grant from Pfizer Inc. The authors would like to thank Mike Jamieson, MD, for his helpful contributions to the development of this project.

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DeSalvo, K.B., Gregg, J., Kleinpeter, M. et al. Cardiac risk underestimation in urban, black women. J GEN INTERN MED 20, 1127–1131 (2005). https://doi.org/10.1111/j.1525-1497.2005.00252.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.00252.x

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