Heart disease hits minority communities harder. Here’s why and what needs to change.

Heart disease remains the leading cause of death in the United States according to Centers for Disease Control and Prevention, but experts say not all communities are impacted equally. For many patients from minority groups, barriers such as delayed access to care, transportation issues, financial hardship, and mistrust in the healthcare system can lead to worse outcomes and earlier disease.

Safwan Gaznabi, MD, cardiologist at Loma Linda University Health, says those disparities manifest in ways long before patients arrive in the hospital.

"I'll often see patients in my office or in the hospital who have had cardiovascular symptoms or conditions for years without adequate diagnosis or treatment," Gaznabi says. "More often than not, access to care is the biggest issue, and that leads to less favorable outcomes."

Who is most affected?

Racial and ethnic disparities in cardiovascular disease are well documented across rates of disease, treatment patterns, hospitalizations, and mortality. According to Gaznabi, adults from Black and Hispanic communities are among those most affected.

"Delays in recognition and treatment contribute to higher rates of cardiovascular disease, heart failure, hypertension at younger ages, strokes, hospitalizations, and higher mortality compared to non-Hispanic white adults," says Gaznabi.

What causes this?

While genetics can play a role, Gaznabi says many of the biggest drivers are tied to social determinants of health, the everyday conditions that shape a person's ability to stay healthy.

These include limited access to nutritious food, fewer safe opportunities for exercise, financial instability, chronic stress, and challenges navigating the healthcare system.

"We talk about food deserts in certain communities," he says. "Some neighborhoods simply don't have the same access to grocery stores or healthy food options. Then you add work schedules, stress, transportation, and the challenge of making ends meet, and preventive health can become very difficult to prioritize."

What barriers are involved?

Transportation and insurance barriers can also delay care. Gaznabi notes that millions of Americans postpone medical appointments each year because they lack reliable transportation or cannot afford out-of-pocket costs.

"Insurance status, cost, transportation, and trust in the medical system profoundly shape if, when, and how patients seek care," he says. "Many people end up relying on emergency departments rather than preventive or primary care."

That delay often means patients arrive with more advanced disease.

"When healthcare conditions are overlooked or delayed, they progress and can have more downstream consequences," Gaznabi says. "Late presentation of serious health issues can cause significant disability and mortality."

Those impacts extend beyond the individual patient.

"If you become sick and unwell, your loved ones are going to take time out of their day to care for you," he says. "It affects the entire family."

What can be done to improve care?

Gaznabi says building trust and listening to patients' concerns is a critical part of improving care. He encourages patients to write down questions before appointments and speak up about barriers they may be facing.

"I try to be sensitive to what people are going through and respectful of their circumstances," he says. "Sometimes patients are dealing with transportation problems, financial stress, or challenges at home that directly affect their health."

What needs to change?

Gaznabi believes improving outcomes will require broader systemic change beyond the exam room.

"It's not just on the patient," he says. "It's on healthcare systems, insurance systems, and policymakers to make sure people can access the care they need."

At Loma Linda University Health, Gaznabi says the institution's mission-centered approach helps providers go beyond treating disease alone.

"The people that work here are generous with their time and their goodwill," he says. "It takes a village to take care of people."

To learn more about heart health or schedule an appointment with a Loma Linda University Health cardiologist, visit LLUH International Heart Institute webpage.