Alcocer Luis, Schiffrin Ernesto L, Fink Gregory, Gironacci Mariela M, Irigoyen María Claudia, Palei Ana C, Prieto Minolfa, Punzi Henry, Molina de Salazar Dora Inés, Ponte-Negretti Carlos I, Ortellado Jose, Peñaherrera Ernesto, Piskorz Daniel, Rosas Martin, Valdez Osiris, Villar Raúl, Wyss Fernando, Ferrario Carlos M
Instituto Mexicano de Salud Cardiovascular, Ciudad de México, México.
Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Québec, Canada.
Am J Hypertens. 2025 Sep 16;38(10):739-747. doi: 10.1093/ajh/hpaf050.
Discrimination in cardiovascular healthcare, particularly concerning hypertension treatment, is a significant and complex issue in Latin America, driven by biases related to gender, ethnicity, and economic status. Although cardiovascular disease is the leading cause of death worldwide, disparities in healthcare delivery endure, especially impacting marginalized populations. Women, ethnic minorities, and economically disadvantaged groups encounter considerable barriers, including underrepresentation in clinical research, delayed diagnoses, and unequal access to guideline-recommended treatments. Economic disparities maintain a divided healthcare system in which the quality of treatment often directly correlates with socioeconomic status, reinforcing inequities and adversely affecting health outcomes in lower-income communities. Ethnic discrimination, stemming from deeply ingrained social biases, leads to inadequate care and limited access to advanced medical technologies, disproportionately impacting indigenous and Afro-descendant populations. Addressing these systemic inequities requires comprehensive strategies that ensure equitable participation in clinical trials, develop tailored public health policies sensitive to socioeconomic and cultural contexts, and implement targeted educational initiatives. Healthcare systems must actively dismantle entrenched biases, improve access for economically disadvantaged communities, and guarantee that ethnic minorities receive treatment of equal quality. The Inter-American Society of Hypertension emphasizes that removing these discriminatory barriers reduces the burden of cardiovascular disease and enhances overall health outcomes across Latin America. This document endorses consensus recommendations detailed in positions 1 through 4, which tackle specific challenges related to personalized care, racial biases in treatment algorithms, socioeconomic healthcare inequalities, and gender disparities in hypertension management.
心血管医疗保健中的歧视,尤其是在高血压治疗方面,是拉丁美洲一个重大且复杂的问题,其受到与性别、种族和经济地位相关的偏见驱动。尽管心血管疾病是全球主要死因,但医疗服务的差距依然存在,尤其对边缘化人群产生影响。女性、少数族裔和经济弱势群体面临诸多障碍,包括在临床研究中的代表性不足、诊断延迟以及难以平等获得指南推荐的治疗。经济差距导致医疗体系分化,治疗质量往往与社会经济地位直接相关,加剧了不平等,并对低收入社区的健康结果产生不利影响。源于根深蒂固的社会偏见的种族歧视,导致医疗护理不足且难以获得先进医疗技术,对原住民和非裔后裔人群的影响尤为严重。解决这些系统性不平等需要全面的策略,确保公平参与临床试验,制定针对社会经济和文化背景的公共卫生政策,并实施有针对性的教育举措。医疗体系必须积极消除根深蒂固的偏见,改善经济弱势群体的就医机会,并确保少数族裔获得同等质量的治疗。美洲高血压学会强调,消除这些歧视性障碍可减轻拉丁美洲的心血管疾病负担并改善整体健康结果。本文件认可立场1至4中详述的共识建议,这些建议应对了与个性化医疗、治疗算法中的种族偏见、社会经济医疗不平等以及高血压管理中的性别差异相关的具体挑战。