Report on Medical Access Finds One-Third of Black Americans Live in ‘Cardiology Deserts’

by Elaine Chen

Many Black Americans would have to travel across county lines just to find an open spot with a cardiologist, a new analysis found.

About 16.8 million Black Americans roughly 1 in 3 live in counties with little or no access to heart specialists, according to a report from GoodRx, a digital health company that provides drug discounts and also researches health trends.

When zooming in on counties that have sizable Black populations, the analysts found that 72% of these counties are “cardiology deserts,” most of them concentrated in southeastern states.

The findings illustrate the barriers to accessing care for a population that already faces a disproportionate burden from cardiovascular disease. It’s the leading cause of death in the U.S., and Black Americans face a 30% higher risk of death from heart disease than white people.

“We’re missing a huge chunk of individuals who really need this care and are having to jump through massive hoops to access that care,” said Tori Marsh, director of research at GoodRx. “When you have to jump through those hoops, you’re likely not going to.”

The analysts used data from Health Link Dimensions, a health data provider, to identify cardiologists across the country, and then mapped their locations to find which counties have cardiology deserts.

Prior research shows that counties with a high proportion of Black and Hispanic people already have less access to primary care doctors, often the first type of provider that people go to. 

But even if patients are able to get primary care, they would still need to see a cardiologist to address specific or urgent issues like heart failure and heart attacks, said Rishi Wadhera, a cardiologist at Beth Israel Deaconess Medical Center.

He noted that the report doesn’t account for how much access to telehealth services people have. But still, many services like cardiac stress tests can’t be performed remotely, said Wadhera, who’s also the section head of health policy and equity at the Smith Center for Outcomes Research.

The researchers also analyzed what the risk of heart disease looked like for people living in cardiology deserts. Using data on diabetes, obesity, smoking, unhealthy diet, physical inactivity, and excessive alcohol consumption, the researchers assigned a score of 0 to 6 to counties, with a higher number meaning a greater risk of heart disease in that county.

Compared with the national average of 2.9, the counties with sizable Black populations that had little or no access to cardiologists had average scores of 3.6 and 4.5, respectively. That means the areas where heart specialists are most difficult to reach are also where specialists may be most needed.

Wadhera said to address these deserts, the federal government could strengthen incentives to encourage medical graduates to pursue practice in communities that have less access to specialists.

Utibe Essien, an assistant professor of medicine at UCLA who researches health disparities, noted that research shows Black patients fare better under the care of Black doctors in particular, but there are also deep issues affecting the supply of Black doctors.

In the South, where most of the cardiology desserts have been identified, there are likely greater disparities in wealth and educational opportunities, and thereby more barriers for Black people to become doctors in their communities, he said.

“The regions that we’re missing a lot of cardiologists are in the South and are in states, cities that likely have high rates of segregation,” he said. 

Heart Disease Targets Black Americans and Poverty, Unemployment Are Big Reasons Why

By Cara Murez HealthDay Reporter

What researchers call 'social factors' are largely responsible for Black Americans having a greater risk of death from heart disease than whites, according to a new study.

Among the social factors that contribute to this racial disparity are unemployment, low income, lack of regular access to health care and lack of a partner, Tulane University researchers said.

“For so many years we have focused on smoking, diet, physical activity, obesity, [high blood pressure], diabetes and high cholesterol and we know those are important" for preventing heart disease, said lead author Dr. Jiang He, chair in epidemiology at Tulane University’s School of Public Health and Tropical Medicine in New Orleans. He added he was surprised that the Black-white difference in heart-disease death rates owes mainly to social factors.

Black Americans are 54% more likely to die of heart disease than white Americans, the study found. This is true even with a substantial overall reduction in heart disease deaths nationwide.

The study used health data from more than 50,000 U.S. adults. The researchers examined links between heart-related deaths and clinical risk factors like obesity, diabetes and high blood pressure as well as lifestyle factors, including smoking, unhealthy diet, lack of exercise and too little or too much sleep.

Researchers also considered social risk factors, such as unemployment, low income, food insecurity, limited education, lack of private health insurance, poor access to health care, and not being married or living with a partner.

Compared to white adults, Black adults had a 54% higher risk of heart-related death, which dropped to 34% after adjusting for clinical factors and 31% after adjusting for lifestyle risk factors. "However, after adjusting for social risk factors, this racial difference totally disappeared,” He said in a university news release.

This research follows another Tulane study that showed Black Americans are 59% more likely to die prematurely than white Americans. Adjusting for social factors referred to as social determinants of health reduced that gap to zero.

He said these findings underscore the importance of well-paying jobs, health care access and social support. He plans to put these findings into practice with a program that aims to address high blood pressure in New Orleans’ Black communities. It will partner with local churches to provide health screening training and free medication.

“It is essential to develop novel community-based interventions for reducing cardiovascular disease risk in Black populations,” He said.


*Study findings were published Aug. 15 in Annals of Internal Medicine.

New VCU-led Research Shows How Stress From Racism Influences Disparities in Heart Health

By Olivia Trani

Heart disease is the leading cause of death in the United States, yet the risk of death from this condition differs by race and ethnicity. Research has shown that Black adults are more likely to have poorer cardiovascular health compared with white adults and other minority groups. They are also more likely to develop risk factors for heart disease, such as obesity and high blood pressure, at an earlier age.

A new study led by Virginia Commonwealth University suggests that chronic stress from discrimination and adverse neighborhood conditions are some of the contributing factors behind this racial disparity. The research also found that the cardiovascular impact of these stressors varied by gender, with Black women more affected by discrimination and Black men more affected by neighborhood safety.

The findings, published in JAMA Network Open, could help providers and community partners better understand how certain stressors impact cardiovascular health within different groups, and thus could aid in the development of interventions. 

“Our goal was to understand what types of factors contribute to the stress experiences of Black people. If we can identify certain stressors to target in our mitigation strategies, we can hopefully improve cardiovascular health outcomes and reduce disparities in heart disease,” said Anika L. Hines, Ph.D., an assistant professor in the Department of Health Behavior and Policy at the VCU School of Population Health and lead author of the new study. Hines heads the Equity in Cardiovascular Health Outcomes Lab, which researches cardiovascular health disparities in Black communities.

Chronic stress and stress-related coping mechanisms are associated with increased heart disease. Experts believe that the cumulation of stress from a lifespan of structural and interpersonal racism may cause Black individuals to have differential stress-related health outcomes.

“We have these natural mechanisms in our body which respond to stressful situations, often referred to your fight-or-flight response. However, being persistently exposed to various stressors can throw your system off balance. Over time, the various systems that are supposed to help you during periods of stress can actually deteriorate your organ functioning,” Hines said.

For this study, Hines and her colleagues utilized data from the REGARDS project, a national study focused on better understanding geographic and racial differences in stroke mortality. They examined survey responses and clinical information collected from more than 7,500 participants.

To assess a person’s cardiovascular health, the researchers generated scores based on four health behaviors (cigarette smoking, diet, physical activity and body mass index) and three health indicators (blood pressure, cholesterol and glucose levels).

In their survey responses, participants reported how often they experienced racial discrimination, including at school, while receiving medical care or from the police. Participants were also asked about the condition of their local neighborhood, such as whether they feel safe, what the noise and traffic level is like and whether there is adequate access to grocery stores, parks and playgrounds. They additionally provided information about how connected they feel to their neighborhood, such as whether neighbors get along, trust one another, share the same values and are willing to help one another.

“We wanted to assess the various ways in which social and physical environments could impact an individual to see if we could understand which factors are contributing to the disparity. Social and economic determinants of health may feel so final that they can’t be adjusted, but these are often a result of policies,” Hines said.

The data showed that Black adults, especially Black women, had poorer cardiovascular health compared with white adults. While Black men had 27% lower odds of having better cardiovascular health than white men, Black women had 55% lower odds than white women - more than double the racial gap among men.

Compared with white participants, Black participants reported higher levels of perceived stress and more often reported instances of discrimination. Black participants also reported worse neighborhood conditions and more often reported that their neighborhoods were unsafe.

The data analysis showed that the disproportionate exposure to these stressors accounted for some of the racial disparity in cardiovascular health. According to the researchers’ calculations, stress from discrimination explained 11% of the racial difference in cardiovascular health between Black and white participants. Stress from neighborhood conditions also influenced this racial disparity, specifically the level of safety (6%), physical features (5%) and social connectedness (1%) within a neighborhood.

The research team discovered that the impact of these stressors varied by gender. Their results showed that discrimination explained 14% of the racial differences in cardiovascular health among women, while neighborhood safety attenuated these racial differences by 12% among men.

These findings suggest that public health approaches for reducing heart disease disparities may be more impactful by strategically targeting certain stressors. For example, addressing the unique stressors that tie into coping with discrimination could be more consequential in Black women, whereas addressing the impact of neighborhood violence may be more important for Black men.

“This study shows the importance of intersectional experiences when considering solutions for health disparities,” Hines said. “Marginalized groups aren’t monoliths. Even in the umbrella of marginalization related to race, there can be differential experiences based on gender, socioeconomic status and other factors.”

Hines and her colleagues are currently working with community members to design feasible interventions for young Black women to combat stress from these unique racial, gendered experiences with discrimination.

“We measure things so that we can do something about it. We hope that our findings help inform strategies, both in terms of policies and therapies, for dismantling these health disparities,” Hines said. “The more evidence we build in this field, the more improvements we can hopefully make in terms of structural change.

Lifestyle Marker Found in Black Adults May Signal Stroke Risk

An organic compound called gluconic acid could serve as a way to identify high blood pressure and stroke risk in Black adults, early research suggests.

By Don Rauf

Black adults may face a greater risk of high blood pressure and stroke if they are found to have a high level of an organic compound called gluconic acid in their body, according to preliminary research presented at the American Stroke Association’s International Stroke Conference 2023 in Dallas (held February 8–10). The study has not been published in a peer-reviewed journal.

“Whether gluconic acid causes high blood pressure or vice versa is yet to be determined in a future study,” says the lead study author, Naruchorn Kijpaisalratana, MD, PhD a research fellow in neurology at Massachusetts General Hospital in Boston. “We think that gluconic acid is a dietary related marker of inflammation, and those with higher stroke risk would have higher gluconic acid level.”

Marker Linked to Cardio Problems in Black but Not White Adults

For the study, Dr. Kijpaisalratana and colleagues examined blood samples collected from 1,075 ischemic stroke survivors during an average follow-up period of seven years. (In an ischemic stroke, a blood clot blocks or narrows an artery leading to the brain.)

Of those, 439 were Black adults and 636 were white adults. Their average age was 70, and participants were about 50 percent male and 50 percent female. The scientists compared these blood results with samples drawn from a group of nearly 1,000 Black and white adults who were similar in age but had not had a stroke. Samples were collected from participants over a four-year period from 2003 to 2007.

Elevated amounts of gluconic acid were found in the samples taken from Black adults who had high blood pressure, but not white participants with high blood pressure. Black adults with the highest gluconic acid levels were 86 percent more likely to have high blood pressure than those with low gluconic acid levels. Black adults with the highest gluconic acid levels also had a 53 percent increased risk of ischemic stroke, but no such association was seen in white participants.

A Biomarker Tied to Lifestyle Practices

The results suggested that higher gluconic acid levels among the Black participants may be related to lifestyle habits — such as consuming foods high in fats, fried foods, processed meats, and sugary drinks (which are often part of a “Southern diet”), as well as a lack of physical activity. Kijpaisalratana added that education levels may also be associated with lifestyle and health behaviors.

“We hypothesize that the changes in behavior including eating a healthy diet and more physical activity would lower gluconic acid levels,” she explains. “But this would require another experimental study to confirm our hypothesis.”

Why Scientists Focused on Gluconic Acid

Gluconic acid is a type of metabolite. Metabolites are substances made or used when the body breaks down food, drugs, chemicals, or its own tissue (for example, fat or muscle tissue). Past research has demonstrated that metabolites are linked to oxidative stress – a condition that may occur when there are too many unstable molecules called free radicals in the body and not enough antioxidants to get rid of them. A growing body of evidence suggests that oxidative stress may play a role in the development of hypertension.  

The researchers focused on gluconic acid after screening 162 metabolites that are relevant to human metabolism; they found that gluconic acid was the only metabolite that demonstrated racial differences.

“What surprised us was that we identified a metabolite that has racial differences in association with the diseases, and this metabolite was linked to social determinants of health including diet, education, and exercise,” said Kijpaisalratana.

Gluconic acid may be considered a dietary-related marker because of its availability in foods (such as fruits, wine, and honey), and it is potentially produced by the gut microbiome, according to study authors. They emphasized that gluconic acid at this point is just a marker of inflammation, and has not been proven to be a cause.

“Our findings did not demonstrate that gluconic acid by itself is harmful,” says Kijpaisalratana. “We demonstrated that gluconic acid could be a marker that links to several health behaviors. Therefore, we suggest that people should maintain their healthy lifestyle through eating healthy and exercising regularly.”

A Potential Tool to Identify Heart Disease Risks

Bruce Oybiagele, MD an associate dean and professor of neurology at the University of California in San Francisco and an American Heart Association expert volunteer, notes that gluconic acid could be a helpful tool for healthcare providers in spotting Black adults who are in danger of having a stroke.

“Given the long-standing higher risk of stroke in Black compared to white adults in the United States, which is so far still not fully explained by a higher frequency of traditional stroke risk factors, the potential discovery of a new prognostic marker or therapeutic target is extremely important,” says Dr. Ovbiagele, who was not involved in the study.

He added that gluconic acid might “serve as an objective measure to inform healthcare professionals about how well their patients are doing in reducing hypertension and stroke risk and may also be helpful to motivate Black patients to modify their lifestyles as appropriate to prevent stroke”

To Make History, A Major Study on Black Heart Health Looked Beyond the Lab

 by Michael Merschel, American Heart Association News

A quarter-century ago, the foundations were laid for the Jackson Heart Study, one of the most significant research efforts in the history of heart health.

As the largest single-site study of Black people's heart health ever undertaken, it would eventually spawn more than 800 scientific papers and provide critical insights on genetics, prevention and more, based on examinations of thousands of Black men and women living in and around Jackson, Mississippi.

But before the study could make scientific history, it had to confront issues that went far beyond the lab, say people who shaped the study. "We did focus on much more than looking through a microscope at something," said Frances Henderson, who started working with the study in 1997, during its design phase, and held multiple positions with it over the decades, including deputy director.

The need for research into the cardiovascular health of Black people was clear, said Dr. Herman Taylor, the study's founding director. "There was a huge gap in terms of death and disability between the Black and white populations in Mississippi. And that was reflective of a gap that could be found across the country."

But Black people had historically been left out of research studies. Taylor, now endowed professor of medicine and director of the Cardiovascular Research Institute at the Morehouse School of Medicine in Atlanta, pointed to the example of the Framingham Heart Study, which established the very concept of risk factors for heart health. The participants in that seminal project, which began in 1948, were 98% white.

Better data on Black men and women clearly was needed. But, Taylor said, the history of all-Black, government-backed studies in the Deep South was problematic. The infamous Tuskegee study, which withheld lifesaving penicillin from Black men so scientists could chart the progress of syphilis, may be the best-known example of how Black people were exploited in the name of science, but it's far from the only one.

The Tuskegee study was shut down in 1972, but Henderson said the history of it and other "horrible things" done in the name of medical research lingers in the minds of many Black Americans. Many think, "I don't want to be a guinea pig," she said. "And I don't want them to find something and not tell me, so they'll let me die."

Broader than the issue of how Black people were treated in medical research, Taylor said, was suspicion and mistrust of a system "that was deeply discriminatory for much of the lives of the people we were seeking to recruit."

Jackson Heart Study designers worked to overcome that legacy by making partners of participants.

"They had to have ownership in the study and feel they were a part of it," Henderson said. "We didn't have them under a microscope, looking at all the things that were wrong with the population and then going back to California somewhere. We were a part of the community."

Study designers listened to Jackson residents' frustrations with the medical system. Some had lived through the era when Black patients had separate, unkempt waiting rooms and were seen only after white patients had been treated.

Henderson, who is retired but continues to serve as a consultant for the study, said trust was fostered in many ways. Potential participants were consulted to make sure language on consent forms was clear. For people who might have trouble reading, videos were recorded. A "council of elders" was made part of hiring decisions. People were promised that lab results would be shared with their primary care doctors.

The Jackson Heart Study did not invent the idea of such community engagement, Henderson said. But designers embraced the concept, which since has been used by many others.

The idea was controversial. "Epidemiological purists" might have said sharing information changes what you're doing from a study into an intervention, Taylor said, but ultimately, designers found that sharing information "was not only not a contradiction to scientific inquiry, but in fact, there was a moral obligation to do so."

The study began enrolling participants in 2000. It eventually recruited more than 5,300 people whose participation would lead to important findings related to the genetics of heart disease, links between discrimination and high blood pressure, the significance of social factors in heart health, and more.

By design, the study's goals went beyond understanding heart disease and into the world of education. Part of this was out of necessity, Henderson said. Jackson lacked experts in public health, so "we had to build our own cadre of health researchers."

So the study created ways to make sure high school students were ready for college and provided career mentors for older students. "That was unusual" for such a study, Henderson said. But it did develop medical experts. Not all of them ended up staying in Jackson—but some did, Henderson said.

It also meant collaborating with some very different educational institutions. Jackson is home to two historically Black colleges: the small, private Tougaloo College, which has educated many of the state's Black health care professionals; and the larger, public Jackson State University, a former teachers college later designated "the Urban University of the State of Mississippi." The city is also home to the University of Mississippi Medical Center. UMMC, part of "Ole Miss," is the state's only academic medical center but didn't graduate a Black doctor until 1972.

Diversity among physicians and researchers can directly benefit Black health, and Henderson said the study helped forge ties that bolstered all three institutions. "It was not easy to do," she said. "But it worked." To Taylor, the study's broad goals meant it had been, and continues to be, "truly audacious, truly ambitious."

Researchers, of course, have not closed the racial gap in heart health. A 2022 study in the American Heart Association journal Circulation showed that between 1999 and 2019, cardiovascular age-adjusted mortality rates declined significantly for both Black and white adults, but Black women and men continue to experience higher cardiovascular mortality rates.

"Research is a slow enterprise," Taylor said. "Way too slow." Participants often say, "As I'm doing this, I realize it may not help me. But I want to do it for the future, and my children." But even as he considers the Jackson Heart Study to be "landmark" in terms of understanding Black health, Taylor said it has been more.

"It is also a source of expanded health literacy in a large Black community," he said. "It is a transgenerational intervention to expand diversity and inclusion of young Black learners into the pipeline of researchers and providers. It is the hub of an international network of scientists of multiple disciplines to better understand human biology as it operates in an environment marked by adverse social and political circumstances. And it is a gift to the world from the Black community of Jackson, Mississippi."

Because ultimately, he said, "discoveries made in Jackson will transcend race and geography just as they have in Framingham."

Black Americans Still at Higher Risk for Heart Trouble

By Amy Norton
HealthDay Reporter

Black Americans have been persistently hard-hit with heart disease risk factors for the past 20 years and social issues like unemployment and low income account for a good deal of it, a new study finds.

Cardiovascular disease, which includes heart disease and stroke, is the No.1 killer of Americans, and it's well-known that it exacts a disproportionate toll on Black Americans.

The new study published Oct. 5 in the Journal of the American Medical Association focused on risk factors for heart and blood vessel disease, such as high blood pressure, diabetes and obesity. And Black Americans carried a heavier burden of those conditions than white, Asian and Hispanic folks, the study authors said.

But the findings also highlight a key reason why.

"A lot of the difference may be explained by social determinants of health," said lead researcher Dr. Jiang He, of Tulane University School of Public Health and Tropical Medicine, in New Orleans.

That term refers to the wider context of people's lives and its impact on their health: A healthy diet and exercise might do a heart good, for instance, but it's easier said than done if you have to work two jobs to pay the rent.

In their study, He and his colleagues were able to account for some of those social determinants: people's educational attainment, income, whether they owned a home, and whether they had health insurance and a regular health care provider.

It turned out those factors went a long way in explaining why Black Americans faced particularly high heart disease risks. The study is not the first to trace the nation's health disparities to social factors, including structural racism - the ways in which society is set up to give advantages to one race over others.

Dr. Keith Churchwell was the lead author of a recent statement from the American Heart Association (AHA) on the subject. In it, the AHA said structural racism needs to be recognized as a "fundamental cause of persistent health disparities in the United States."

Churchwell said the new findings are in line with past evidence, the kind that drove the AHA statement. Racial disparities in health start with things as fundamental as educational opportunities, nutrition, stable housing and transportation, according to Churchwell, who is also president of Yale New Haven Hospital in Connecticut.

"I think we're all coming to the realization that if we're going to improve the health of our communities, these social determinants have to be addressed," said Churchwell, who was not involved in the new study. "They have a bigger impact than the medications we give and the procedures we do."

For the study, He's team used data from a long-running federal health survey. The investigators found that between 1999 and 2018, Americans saw an increase in certain risk factors for heart disease and stroke. The prevalence of obesity soared from 30% to 42%, while the rate of diabetes rose from 8% to almost 13%.

Meanwhile, average blood pressure levels held fairly steady, while blood sugar levels rose. The picture differed by race and ethnicity, however, and Black Americans were consistently worse off than white, Asian and Hispanic Americans.

And by 2018, Black adults had, on average, an 8% chance of developing heart disease or stroke in the next 10 years (based on their risk factors). That compared with a roughly 6% chance among white Americans, the investigators found.

Then He's team weighed the social factors that they could. And those issues appeared to explain a large amount of the difference between Black and white Americans' cardiovascular risks.

Still, He said, the survey did not capture other, more nuanced factors. For example, can people afford healthy food? Do they have safe places for exercise?

Even asking people about "access" to health care fails to tell the whole story, He noted: The quality of that care including whether providers and patients are communicating well with each other is critical.

"If we want to improve population health," He said, "we need to pay attention to these social determinants."

According to Churchwell, health care systems can help tackle broader issues in various ways, including partnering with community organizations and evaluating themselves with the help of electronic medical records to ensure they are providing equitable care.

It is not enough to simply tell patients to eat better and exercise, Churchwell said.

From the patient side, he encouraged people to ask about resources in their community, for help with anything from exercise to mental health support.

"Say to your provider, 'Help me figure this out,'" Churchwell said.

Researchers Explore How COVID-19 Affects Heart Health in Black Women

 By American Heart Association News (8/25/20)

Nearly six months into the COVID-19 pandemic, two things have become clear: The virus profoundly impacts people with heart disease and disproportionately impacts Black people. But the many manifestations of these disparities remains unclear, particularly for one group regularly left out of medical research.

"African American women are often at the intersection of the worst economic and health disparities," said Dr. Michelle Albert, a cardiologist and professor of medicine at the University of California, San Francisco. "They are a group that is often overlooked."

In a collaborative investigation with the Slone Epidemiology Center at Boston University, Albert is leading a study to look at a cohort of women enrolled in the Black Women's Health Study to determine the myriad ways in which COVID-19 is impacting them.

She said she chose to study this demographic because Black women often are at higher risk for heart disease than women in other demographic groups, and they are shouldering an excessive burden during the pandemic.

African Americans with COVID-19 are nearly three times as likely to require hospitalization than white people with the disease, according to a recent study published in the journal Health Affairs. According to statistics compiled by the nonprofit American Public Media Research Lab, Black and Indigenous people die from COVID-19 at more than three to four times the rate of white people.

Cardiovascular disease, research shows, could play a substantial role in those deaths. And for African American women especially, the risks for heart disease are high. Four out of 5 Black women are considered overweight or have obesity – the highest rate of any group in the country, according to the U.S. Office of Minority Health, and they are 60% more likely to have high blood pressure than their white counterparts.

Those risks didn't happen in a vacuum, experts say. Numerous factors place greater stress on African American women that can affect their health.

"The United States has a longstanding history of disparities in education, income, wealth and housing, and these factors, or social determinants of health, disproportionately affect African Americans – and African American women in particular," said Yvonne Commodore-Mensah, assistant professor at Johns Hopkins School of Nursing and the School of Public Health in Baltimore. She also is a faculty member at Johns Hopkins' Center for Health Equity.

"These social determinants of health result in a burden of underlying risk factors for COVID-19: high blood pressure, diabetes, overweight and obesity. These risk factors increase the risk for severe COVID-19 illness and mortality."

African American women may also be more exposed to contagion, said Dr. LaPrincess Brewer, assistant professor of medicine in the Mayo Clinic's department of cardiovascular medicine in Rochester, Minnesota. "They are more likely to hold service sector jobs that increase their risk of exposure to COVID-19. They are more likely to serve as heads of household."

What's more, Albert said, "they are caregivers of multiple generations, including children and elderly relatives and extended family. And they are more likely to experience every kind of bias – medical as well as racial/ethnic biases – in housing and employment."

All of these factors multiply stress, which can impact heart health. "This pandemic has really affected the livelihood of the African American community and the ability of community members to maintain a healthy lifestyle," said Brewer. "It's largely related to the extreme burden of stressors resulting from this crisis."

But as evidence begins to emerge showing COVID-19 has a widespread, adverse impact on cardiovascular health, the data is not being collected in ways that allow researchers to look at its impact on specific demographic groups – information that could be critical in helping to identify treatments and prevention strategies for those at highest risk.

Albert's study was among a dozen recently funded by the American Heart Association to investigate heart and brain issues related to COVID-19. The AHA also created a COVID-19 CVD Registry that is working to enroll historically underrepresented groups. The registry is collecting data from thousands of COVID-19 patients nationwide to advance the work of scientists, doctors and researchers investigating the coronavirus.

Albert said she hopes her research findings pinpoint the experiences and perceptions of African American women so that targeted solutions can be developed. The research community needs to do more studies like this, those in the field say.

"When we collect data, we have to report it systematically, so we can analyze it to understand what complications may affect African American women differently than white women," Commodore-Mensah said. "Without this data, we have an incomplete picture of what affects the risk for severe COVID-19 illness and death.

"Women in general are not well represented in research studies on cardiovascular health," she said. "Compounding that, Black women are less represented than white women, for different reasons."

They may be unable to get off work to take part in clinical trial visits, she said. Or those recruiting patients may lack cultural sensitivity. Further compounding the issue is a deep-seated distrust of the medical research community, which has a long history in the United States of unethical treatment, abuse and exploitation of African American patients.

Commodore-Mensah said those challenges could be overcome by doing a better job of communicating the benefit of research studies and making sure trusted individuals, such as faith and community leaders, are the ones delivering those messages.

"We also need to make sure the research team reflects the population we are studying," she said.