Men's Heart Disease Rates Differ by Race, State

A new study finds that both race and geographical location are serious risk factors for heart disease in men.

Researchers at the Centers for Disease Control and Prevention (CDC) and West Virginia University compared death rates from across the country. Men's health expert Dr. Jean Bonhomme, who was not involved with the study, discusses its importance with the Early Show.

Bonhomme is on the board of the Men's Health Network, a public education organization based in Washington, DC that works to raise awareness of men's health issues. Bonhomme, who specializes in African-American men's health issues, is also a senior faculty associate at the Emory University School of Public Health in Atlanta, Georgia.

According to the study, called "Men and Heart Disease: An Atlas of Racial and Ethnic Disparities in Mortality," men who live in the rural South and African-American men throughout the United States have the highest heart disease mortality rate compared to men in other regions and other ethnic groups.

The study is the first comprehensive look at the geographical, racial, and ethnic disparities of heart disease deaths for men in the United States aged 35 years and older.

According to one of the study's researchers, this study "reflects differences in opportunities for healthy living and differences in access to healthy living." In general, the researchers found that underlying social and economic factors strongly impact the heart disease death rate.

Other risk factors include lack of social support, depression, job stress, poor work environment, racism, and discrimination. The findings are based on heart disease death rates from 1991 through 1995.

Last year, a companion study was released that analyzed heart disease among women based on geographic location, race, and ethnicity. Both studies found that higher death rates from heart disease were concentrated in the same parts of the country and in the same racial and ethnic groups.

Bonhomme says that the disparities in mortality don't appear to be related to genetics. "The study stressed social inequalities and lack of access to opportunity for healthy living," he says. "We have known for years that cholesterol, cigarette smoking, and blood pressure are risk factors for heart disease and we have been telling people, with little success, to change their diet, stop smoking, and to lose weight. [The researchers] are saying there are social inequalities that were preventing them [the subjects] from living healthy lifestyles."

Lack of access to cardiac rehabilitation facilities is also a major issue for people in some areas of the country, he says.

African-American men traditionally have a diet that is very high in salt, which, together with a sedentary lifestyle, causes problems. "African Americans have higher rates of diabetes and hypertension that are associated with heart disease," Bonhomme says.

Males in general, and African-merican men in particular, try to be stoic when it comes to enduring pain. This is a problem, Bonhomme says. As an example, he mentioned an 8-year-old boy who acted this way when faced with pain from a skinned knee. "He is told that brave boys don't cry," says Bonhomme.

This attitude can hurt men years later when they have a heart problem, he says. Men are often reluctant to go to a doctor. "Stoicism is highly prized in our culture," he says. "It helps on the football field or battlefield, but it's not a good interface with the healthcare field."

Some African-American men may also have distrust for the medical community, so they avoid regular checkups and only visit a doctor when a health problem becomes serious.

In some cases, Bonhomme says, distrust can be traced to the Tuskegee trial, a study that occurred many years ago, in which African-American men were not treated for syphilis so that researchers could study what the disease would do.

"I am surprised at how mch I hear African-American men say, 'Don't go to that hospital, you will never come out again.' Unfortunately, that's a self-fulfilling prophecy. It may be true, but it may be because they go to get medical care too late."

Bonhomme says this study strengthens the information reported last year about women's heart disease rates based upon where they lived, their race, and ethnicity. Together, these two studies show that more emphasis should be placed on public education about health problems--especially men's health issues.

"I am surprised of the general level of lack of awareness about men's health problems. People say 'prostrate' instead of 'prostate,'" he notes. "More money should be invested in prevention, and there should be better funding to health departments that are trying to do outreach."

The study also shows where the need for more information is greatest. "The real strength of the study is that it tells health departments where to target resources, when you have limited healthcare dollars."
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