Reducing inequalities in cardiovascular disease: focus on marginalized populations considering ethnicity and race

Abstract

Cardiovascular disease (CVD) and its risk factors are more prevalent among traditionally marginalized racial, ethnic, and Indigenous groups. These populations also often face greater barriers to accessing cardiovascular health care, further contributing to the health equity gap. To address the challenge of inequalities and disparities in cardiovascular health outcomes, the Lancet Regional Health-Europe convened experts to evaluate the current state of knowledge on inequalities and disparities in cardiovascular health among marginalized populations and propose recommendations to address these disparities. This Series paper aims to review disparities in CVD referring to coronary heart disease and stroke, based on race, ethnicity, ancestry, and Indigeneity emphasizing the intersection of these factors with sex, gender, and socioeconomic status (SES) across Europe and North America. These regions were chosen as they have well established health-care systems, with persistent, and in some regions widening, disparities in cardiovascular health and outcomes. Ethnicity and race should be measured in a standardized manner in health-care administrative databases to identify high risk groups who might need focused programmes to improve health-care access and to address bias and inequities in care. Strategies that policymakers, health-care professionals, and advocacy groups can use to advance cardiovascular health equity include improving access to health-care systems and research for high-risk communities, fostering trust between these communities and public health providers, and enhancing the delivery of evidence-based therapies for the prevention and treatment of CVD.

Keywords: Cardiovascular disease; Ethnicity; Health equity; Race.

Fig. 1

Framework for understanding inequalities and disparities in cardiovascular health for marginalized populations. Conceptual framework illustrates multifaceted and intersecting determinants contributing to inequalities in cardiovascular health among disadvantaged populations. Cardiovascular health is positioned at the center, as the primary outcome of interest, while genetics, sociopolitical context, health access, environment, and ancestry are depicted as key influencing domains. Circular connections between domains signify mutual influence rather than unidirectional relationship. Dashed arrows represent indirect influences, while solid arrows indicate contributing factors extending from the conceptual model. This emphasizes that various structural and environmental determinants shape cardiovascular health and not a directional effect away from health.

Fig. 2

Innovative solutions to improve health disparities. Figure presents patient-centered, culturally sensitive solutions aimed at increasing health equity. Blue boxes represent broad solution categories; white boxes outline specific interventions within each category. While all proposed interventions aim to reduce health disparities—including cardiovascular disease—some may be more impactful depending on context. The basis for these interventions stems from expert recommendations, policy initiatives, and published consensus guidelines.