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Uncovering heart health inequities through research
A part of Point32Health, the Harvard Pilgrim Health Care Institute has been an affiliate of Harvard Medical School and home to the Department of Population Medicine since 1992, forming a unique collaboration dedicated to innovative teaching and research, and the nation’s first medical school appointing department based in a health plan. The Institute’s work addresses a broad range of health care issues such as health care delivery, prevention efforts, policy, and public health.
“The Institute uses its unique position within both a medical school and a health plan to conduct research that seeks to identify effective interventions and systems of care that can improve health care delivery, inform and enhance prevention efforts, evaluate and inform health care policy, and contribute to public health.” –Richard Platt, MD, MSc, President, Harvard Pilgrim Health Care Institute, Professor and Chair, Department of Population Medicine
Making informed improvements
Working in partnership with the Institute allows the opportunity to learn about the impact of new policies and approaches within various areas of health care from the research and findings DPM has produced. Prevention research, for instance, is one of the five areas of focus and is conducted to help reduce the risk of acquiring a disease and/or preventing its consequences. Heart disease and its connection to health equity is just one example of the DPM’s prevention research.
And while there’s still plenty of work to be done to advance heart health equity, our organization can take the Institute’s learnings to help inform the programs and resources we offer members of Harvard Pilgrim Health Care and Tufts Health Plan.
Recently we spoke with Izzuddin M Aris, PhD, an assistant professor in the Department of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School to learn more about his research related to health equity and heart disease. Here’s what he had to share:
Q: You’ve been involved in numerous research studies, particularly when it comes to childhood development and heart disease. Can you discuss how the neighborhood, the area where someone lives, can have an effect on people when it comes to heart health?
Izzuddin M Aris, PhD: Recent research has pointed to how structural factors – conditions in which people are born, live, work, and age, and the systems shaping daily life conditions – are emerging as key drivers of health. Accordingly, neighborhoods have emerged as highly relevant contexts because they possess both physical (such as neighborhood walkability or green space) and social attributes (such as quality of schools, transportation services, access to healthy food choices, and health care services) which could potentially affect the health of individuals directly, or indirectly by influencing educational attainment, employment, income, and health behaviors, among other factors. For example, children living in neighborhoods with high rates of poverty and/or crime have increased risk of obesity, which is a risk factor for poor heart health in adulthood. In a recent study, adults living in less walkable neighborhoods had a higher predicted 10‐year risk of cardiovascular disease compared with those living in highly walkable areas.
Q: In your research published in December 2022, you concluded children who reside in higher-opportunity and lower-vulnerability neighborhoods have lower obesity risk. What are the key messages you think should be conveyed that emanate from your results? What do you want people to take away from this study?
IA: This research focuses on how community resources can enhance children’s health outcomes. The Child Opportunity Index, Social Vulnerability Index, and other measures of neighborhood characteristics could help inform efforts to reduce neighborhood barriers and improve access to community resources so families can better support their children’s health and well-being. These findings suggest that living in a high-opportunity or low-vulnerability neighborhood is an important resilience factor that may promote favorable body mass index patterns which, in turn, could reduce future chronic disease risk. Importantly, this study bolsters the need for a focus on investments that address the structures that consistently compromise the health of marginalized communities.
Q: What are you seeing in terms of improvement (if any) when it comes to heart health disparities?
IA: Racial and ethnic differences in heart health have been well documented. For example, Black and Hispanic Americans have up to twice the risk of death from cardiovascular disease compared with White Americans. Although deaths from cardiovascular disease have decreased substantially since the 1950s, Black and Hispanic populations still have a higher prevalence of cardiovascular disease precursors such as high blood pressure, diabetes and obesity compared with individuals in other racial and ethnic groups. Recent studies have shown that these disparities still persist. A study in over 50,000 US adults reported that 20-year trends (between 1999 and 2018) in cardiovascular risk factors such as body mass index and systolic blood pressure were persistently higher in Black vs. White individuals, even after accounting for important social determinants of health, such as education, income, housing, employment, health insurance, and access to health care. This analysis, however, did not include other social determinants of health such as neighborhoods and physical environment, access to healthy foods, and social integration; it is possible that these factors play an equally important role in racial and ethnic differences in heart health.
Q: What’s been the most surprising thing you’ve learned from your own research?
IA: It has been hypothesized that all children are born with optimal cardiovascular health. Yet, less than 1 in 10 pregnant women in the US have optimal cardiovascular health, and poor cardiovascular during pregnancy is linked with poor cardiometabolic health in offspring, suggesting that optimal cardiovascular health may not be universal even at birth. A study in 2022 reported that between 2013 and 2018, only 2% of US children aged 2-19 years had optimal cardiovascular health. A more surprising finding in my recent research in ~300 children aged 4-7 years found that no children had optimal cardiovascular health. The low prevalence of optimal cardiovascular health in children, together with research showing long-term benefits of having optimal CVH (i.e., longer lifespan and improved overall quality of life) emphasizes the importance of optimizing cardiovascular health early in life.
As an organization, we look forward to the continued partnership between Point32Health and the Harvard Pilgrim Health Care Institute, and utilizing the research as a catalyst to drive evolution and change in the health care system to create better outcomes and drive better health for our members.
And for more on heart health equity, check out our recent Boston Globe feature: