Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
J Am Coll Cardiol. 2021 Dec 21;78(25):2580-2588. doi: 10.1016/j.jacc.2021.10.021.
Significant race- and ethnicity-based disparities among those diagnosed with dilated cardiomyopathy (DCM) exist and are deeply rooted in the history of many societies. The role of social determinants of racial disparities, including racism and bias, is often overlooked in cardiology. DCM incidence is higher in Black subjects; survival and other outcome measures are worse in Black patients with DCM, with fewer referrals for transplantation. DCM in Black patients is underrecognized and under-referred for effective therapies, a consequence of a complex interplay of social and socioeconomic factors. Strategies to manage social determinants of health must be multifaceted and consider changes in policy to expand access to equitable care; provision of insurance, education, and housing; and addressing racism and bias in health care workers. There is an urgent need to prioritize a social justice approach to health care and the pursuit of health equity to eliminate race and other disparities in the management of cardiovascular disease.
在被诊断患有扩张型心肌病 (DCM) 的人群中,存在着显著的基于种族和民族的差异,这些差异深深地植根于许多社会的历史中。种族差异的社会决定因素的作用,包括种族主义和偏见,在心脏病学中往往被忽视。黑人患者中 DCM 的发病率更高;黑人 DCM 患者的生存率和其他预后指标更差,接受移植的患者更少。黑人患者的 DCM 认识不足,也没有被推荐进行有效的治疗,这是社会和社会经济因素复杂相互作用的结果。管理健康社会决定因素的策略必须是多方面的,并考虑改变政策以扩大获得公平护理的机会;提供保险、教育和住房;并解决医疗保健工作者中的种族主义和偏见。当务之急是优先考虑医疗保健的社会公正方法和追求健康公平,以消除心血管疾病管理中的种族和其他差异。