Social-Strata-Related Cardiovascular Health Disparity and Comorbidity in an Aging Society: Implications for Professional Care

Ai, Amy L., Carrigan, Lynn T., Health and Social Work

Aging-related cardiovascular disease (CVD) includes coronary heart disease (CHD), ischemic attack in the brain (stroke), high blood pressure (hypertension), irregular heart beat (arrhythmia), and congestive heart failure (CHF). The demographic trend of population aging in the United States will inevitably increase the incidence of CVD, a fact that presents both challenges and opportunities for the social work profession, especially as related to new findings about significant health disparity and mental health comorbidity in CVD. As a major force in the health system, the social work profession must consider a dramatically expanded role in CVD-related health, mental health, and aging care in its commitment to services for disadvantaged populations.

Newly published national data spotlight the increasing need for CVD-related social services for the aging population. Among older people with CHD, about half have difficulty with one or more activities of daily living (ADL), and two-fifths require assistance (American Heart Association [AHA], 2005). They are more likely to use prescription drugs and social services (for example, a social worker, adult day care, rehabilitation, transportation, and Meals on Wheels) than their younger counterparts. They also tend to experience early retirement and low satisfaction with retirement (National Academy on an Aging Society, 2000a). Advanced age and social and environmental factors (for example, insufficient home care, living alone, and coping difficulties) increase the risk of hospital readmission (Berkman, Millar, Holmes, & Bonander, 1991). A study showed that nearly half of CHF readmissions were primarily due to social problems and lack of community services (Proctor, Morrow-Howell, Li, & Dore, 2000).

According to national data and current research, social-strata-related disparity and associated comorbidity further complicate the increasing demand for professional care. However, many social workers in health care and education may not recognize the scope of the issue needing their clinical attention. In this article, we aim to increase awareness of and enhance professional influence in cardiac care for an aging society.

CVD-RELATED HEALTH DISPARITIES

In the past century, CVD has had a significant effect on society and the U.S. population. Social workers must be attentive to the financial, socioeconomic, and public health consequences of CVD and the related disparity in health. According to the AHA (2005), the estimated cost of CVD and stroke was $393.5 billion in 2005, nearly $175 billion more than that of all cancers and HIV infections. Indeed, CVD claims as many fives as the next five leading causes of death combined (that is, cancer, chronic lower respiratory diseases, accidents, diabetes mellitus, and influenza or pneumonia) each year.

With narrowing coronary arteries that lead to insufficient blood and oxygen supply, CHD causes angina pectoris (chest pain), myocardial infarction (MI, or heart attack), and sudden cardiac arrest. CHD is the single largest killer of Americans among all CVDs (National Academy on an Aging Society, 2000a) and the leading reason for short-stay hospitalization and permanent disability in the U.S. labor force. It accounts for nearly one-fifth of social security disability insurance payments (AHA, 2003, 2005; National Academy on an Aging Society, 2000a).

Differential Effects of CVD, by Gender and Socioeconomic Status

Gender Effects. CVD is the leading cause of premature death for men and women of all racial and ethnic groups, claiming 1.4 million lives in 2002 (AHA, 2005). Since 1984, more women have died of CVD than men, and this gap continues to increase dramatically (AHA, 2003). Average annual rates of first major CVD event rise from 0.7 percent for men ages 35 to 44 to 6.8 percent at ages 85 to 94 (AHA, 2005). Comparable rates occur 10 years later for women, but the gender gap narrows with advancing age. The rate of CVD is greater in women than men after age 75.

After menopause, women are two to three times more likely to have CHD than premenopausal women of the same age (AHA, 2005). The average age of a person experiencing a first MI is 65.8 for men and 70.4 for women. Because of their older age, more women (nearly two-fifths) than men (one-quarter) will die within a year after suffering a recognized MI and will die within a few weeks of any occurrence. Among survivors, MI considerably increases the risk of another MI, sudden death, angina pectoris, heart failure, or stroke. Within six years, slightly fewer than one-sixth of men and about half of women will be disabled with heart failure.

Socioeconomic Status (SES)--Related CHD Disparity. CVD strikes many workers of lower SES. Its mortality and morbidity are also related to SES, suggesting the indirect influence of unhealthy food, lack of access to health care, and increased socioenvironmental stress (Krantz, Sheps, Carney, & Natelson, 2000). The premature death rate from CHD for male manual workers (for example, builders) is almost two-thirds higher than that for nonmanual workers (for example, lawyers). The comparable rate for female manual workers is more than twice as high as for their nonmanual counterparts (AHA, 2003). Monthly earnings for workers with heart disease are considerably lower than for other workers (National Academy on an Aging Society, 2000a).

Differential Effects of CVD, by Race and Ethnicity

The burden of CVD falls disproportionately on several racial and ethnic minority populations (AHA, 2003, 2005). National data on major types of CVD are summarized by race and ethnicity and sometimes by gender in the following sections (the most recent numbers are shown in Table 1) (AHA, 2005). Although not all minority groups show the worst health conditions in every CVD category, the related health gaps between them, especially between black and white people, are nonetheless apparent.

Racial Disparities in Major Disabling Types of CVD. Rates of CVD prevalence are higher in black than in white people of both genders (AHA, 2005) (Table 1). Data from a different source, the Centers for Disease Control and Prevention (1998), show that black people are more likely than white people to die from heart disease, and this racial gap has widened since the 1980s. As for MI, the most deadly form of CHD, although rates are higher in white men than in black men, they are lower in nonblack women than in black women (Table 1) (AHA, 2005). In addition, stroke is a leading cause of serious, long-term disability in the United States. In those ages 65 to 85, racial and ethnic minority populations have a higher relative risk of stroke death (AHA, 2003). More recent information shows that both American Indians or Alaska …

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Publication information: Article title: Social-Strata-Related Cardiovascular Health Disparity and Comorbidity in an Aging Society: Implications for Professional Care. Contributors: Ai, Amy L. - Author, Carrigan, Lynn T. - Author. Journal title: Health and Social Work. Volume: 32. Issue: 2 Publication date: May 2007. Page number: 97+. © 1999 National Association of Social Workers. COPYRIGHT 2007 Gale Group.

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