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Race and Ethnicity With Atherosclerotic Cardiovascular Disease Outcomes Within a Universal Health Care System:
Marc-André d'Entremont1, Dennis Ko2, Andrew T Yan3
1Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
Insights
Racial disparities in atherosclerotic cardiovascular disease (ASCVD) were examined in Canada’s universal healthcare system. Black participants had lower ASCVD risk than White participants, while South Asian risk was attenuated, suggesting healthcare access impacts outcomes.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Racial and ethnic disparities in atherosclerotic cardiovascular disease (ASCVD) persistence within universal healthcare systems remain unclear.
- This study investigates long-term ASCVD outcomes in a single-payer system in Québec, Canada, with comprehensive drug coverage.
Purpose of the Study:
- To explore long-term ASCVD outcomes across racial and ethnic groups within a universal healthcare system.
- To determine if universal healthcare and drug coverage mitigate existing ASCVD disparities.
Main Methods:
- Utilized the CARTaGENE (CaG) prospective cohort study.
- Included 18,880 participants aged 40-69 without prior ASCVD.
- Primary endpoint: time to first ASCVD event (composite of cardiovascular death, acute coronary syndrome, ischemic stroke, or peripheral arterial vascular event).
Main Results:
- Over 6.6 years, Black participants showed lower ASCVD risk (HR, 0.52) compared to White participants after adjustments.
- South Asian participants' increased ASCVD risk was attenuated (HR, 1.41) after adjustments.
- No significant ASCVD outcome differences were found for Middle Eastern, Hispanic, East-Southeast Asian, Indigenous, or mixed race-ethnicities compared to White participants.
Conclusions:
- Universal healthcare and drug coverage may reduce ASCVD risk in Black populations compared to White populations.
- Intensive risk-factor modification could potentially mitigate ASCVD risk in South Asian populations.
- Further research is needed to confirm the impact of universal healthcare access on ASCVD rates in diverse populations.
Background:
It remains unclear whether racial and ethnic disparities for atherosclerotic cardiovascular disease (ASCVD) persist within universal health care systems. We aimed to explore long-term ASCVD outcomes within a single-payer health care system with extensive drug coverage in Québec, Canada.
Methods:
CARTaGENE (CaG) is a population-based prospective cohort study of individuals aged 40 to 69 years. We included only participants without previous ASCVD. The primary composite endpoint was time to the first ASCVD event (cardiovascular death, acute coronary syndrome, ischemic stroke-transient ischemic attack, or peripheral arterial vascular event).
Results:
The study cohort included 18,880 participants followed for a median of 6.6 years (2009 to 2016). The mean age was 52 years, and 52.4% were female. After further adjustment for socioeconomic and cardiovascular factors, the increase in ASCVD risk for South Asians (SAs) was attenuated (hazard ratio [HR], 1.41; 95% confidence interval [CI], 0.75, 2.67), whereas Black participants' risk was lower (HR, 0.52; 95% CI, 0.29, 0.95) compared with White participants. After similar adjustments, there were no significant differences in ASCVD outcomes among the Middle Eastern, Hispanic, East-Southeast Asian, Indigenous, and mixed race-ethnicities participants and the White participants.
Conclusions:
After adjustment for CV risk factors, the risk of ASCVD was attenuated in the SA CaG participants. Intensive risk-factor modification may mitigate the ASCVD risk of the SAs. Within a universal health care context and comprehensive drug coverage, the ASCVD risk was lower among Black compared with White CaG participants. Future studies are needed to confirm whether universal and liberal access to health care and medications can reduce the rates of ASCVD among the Black population.
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