Race and ethnicity are social, political, historical, and cultural constructs.1,2 As such, they are flawed as biological concepts and inappropriate or, at best, imprecise when used as proxy for genetic or other biological phenomena.1,2,3,4,5 Consistent with this premise, racial and ethnic differences observed in the incidence, prevalence, morbidity, and mortality of cardiovascular diseases (CVD) should not be construed as necessarily resulting from genetic or other biological differences. Additionally, race and ethnicity are often confounded by socioeconomic status (SES). Thus, observed racial and ethnic differences that are not appropriately adjusted for SES and related factors could lead to erroneous conclusions with potentially adverse clinical and public health implications. Despite these challenges, data on race and ethnicity, when properly collected, analyzed, and interpreted, can be invaluable in clinical and public health practice.6,7,8 In particular, the appropriate collection and use of data on race and ethnicity are crucial in the quest to eliminate racial and ethnic disparities in cardiovascular health and advance health equity.9,10
In this chapter, we first address the historical origins and definitions of race and ethnicity, and how the terms have been used within the context of clinical and public health practice in the United States. The established racial and ethnic differences in the magnitude, distribution, outcomes, and trends of leading cardiovascular causes of morbidity and mortality are then presented with emphasis on their trends over the past 25 years. The role that research has played in advancing knowledge on race, ethnicity, and CVD is summarized. We identify the critical gaps in knowledge about race, ethnicity, and CVD that present strategic opportunities for future cardiovascular research to advance health equity.
BACKGROUND AND HISTORICAL PERSPECTIVE
Historical and anthropologic data suggest that the ideology of race was well established in the United States by the 18th century.3 At that time, the three major labels that were used to define, group, and rank people were “European whites,” “Native Americans” or “Indians,” and “Negroes” from Africa.3 These were purely social, legal, and political constructs that had no basis in biological evidence. As Richard Cooper eloquently stated, although race is devoid of any aspects of the “dominant empiricism of modern biology,” clinical medicine and public health practice in the United States have embraced racial/ethnic categories as “fundamental structural elements."11 This use of race/ethnic categories in clinical medicine and public health has remained contentious and controversial, especially when race is viewed or interpreted as a biological construct.12
Historically, the biological concept of race has been associated with hierarchical ranking, biological determinism, eugenics, and justification for genocide, colonialism, slavery and other social inequities.13 It should not be a surprise that the use of racial classifications in medicine is met with skepticism and fear. A major problem with using race as an ...