Reducing Cardiovascular Disparities Through Community-Engaged Implementation Research: A National Heart, Lung, and Blood Institute Workshop Report

Cardiovascular disparities remain pervasive in the United States. Unequal disease burden is evident among population groups based on sex, race, ethnicity, socioeconomic status, educational attainment, nativity, or geography. Despite the significant declines in cardiovascular disease mortality rates in all demographic groups during the last 50 years, large disparities remain by sex, race, ethnicity, and geography. Recent data from modeling studies, linked micromap plots, and small-area analyses also demonstrate prominent variation in cardiovascular disease mortality rates across states and counties, with an especially high disease burden in the southeastern United States and Appalachia. Despite these continued disparities, few large-scale intervention studies have been conducted in these high-burden populations to examine the feasibility of reducing or eliminating cardiovascular disparities. To address this challenge, on June 22 and 23, 2017, the National Heart, Lung, and Blood Institute convened experts from a broad range of biomedical, behavioral, environmental, implementation, and social science backgrounds to summarize the current state of knowledge of cardiovascular disease disparities and propose intervention strategies aligned with the National Heart, Lung, and Blood Institute mission. This report presents the themes, challenges, opportunities, available resources, and recommended actions discussed at the workshop.

[1]  M. Cramer,et al.  Community Advisory Board Members’ Perspectives Regarding Opportunities and Challenges of Research Collaboration , 2018, Western journal of nursing research.

[2]  Sarah J. Flynn,et al.  A bundled quality improvement program to standardize clinical blood pressure measurement in primary care , 2018, Journal of clinical hypertension.

[3]  Sharon E Straus,et al.  Erratum to: Mapping training needs for dissemination and implementation research: lessons from a synthesis of existing D&I research training programs , 2017, Translational Behavioral Medicine.

[4]  M. Glymour,et al.  Association Between Birth in a High Stroke Mortality State, Race, and Risk of Dementia , 2017, JAMA neurology.

[5]  Fan Li,et al.  Review of Recent Methodological Developments in Group-Randomized Trials: Part 1-Design. , 2017, American journal of public health.

[6]  Rebecca W. Stubbs,et al.  Trends and Patterns of Geographic Variation in Cardiovascular Mortality Among US Counties, 1980-2014 , 2017, JAMA.

[7]  D. Goff,et al.  Cardiovascular Mortality Differences-Place Matters. , 2017, JAMA.

[8]  Timothy J. Cunningham,et al.  Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans — United States, 1999–2015 , 2017, MMWR. Morbidity and mortality weekly report.

[9]  Naihua Duan,et al.  An Overview of Research and Evaluation Designs for Dissemination and Implementation. , 2017, Annual review of public health.

[10]  J. Weinstein,et al.  Communities in Action: Pathways to Health Equity , 2017 .

[11]  Rachel C. Shelton,et al.  Advancing understanding of the sustainability of lay health advisor (LHA) programs for African-American women in community settings , 2017, Translational behavioral medicine.

[12]  Lisa H. Chung,et al.  Achieving Health Equity Through Community Engagement in Translating Evidence to Policy: The San Francisco Health Improvement Partnership, 2010–2016 , 2017, Preventing chronic disease.

[13]  E. Brunner Social factors and cardiovascular morbidity , 2017, Neuroscience & Biobehavioral Reviews.

[14]  Timothy M. Herr,et al.  Mapping the evolving definitions of translational research , 2017, Journal of Clinical and Translational Science.

[15]  Sharon E Straus,et al.  Mapping training needs for dissemination and implementation research: lessons from a synthesis of existing D&I research training programs , 2017, Translational behavioral medicine.

[16]  Fan Li,et al.  Review of Recent Methodological Developments in Group-Randomized Trials: Part 2-Analysis , 2017, American journal of public health.

[17]  G. de los Campos,et al.  Heat Maps of Hypertension, Diabetes Mellitus, and Smoking in the Continental United States , 2017, Circulation. Cardiovascular quality and outcomes.

[18]  Rose A Rudd,et al.  Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. , 2016, MMWR. Morbidity and mortality weekly report.

[19]  S. D. de Ferranti,et al.  Cardiovascular Consequences of Childhood Secondhand Tobacco Smoke Exposure: Prevailing Evidence, Burden, and Racial and Socioeconomic Disparities A Scientific Statement From the American Heart Association , 2016, Circulation.

[20]  Douglas A. Luke,et al.  Forging a link between mentoring and collaboration: a new training model for implementation science , 2016, Implementation Science.

[21]  Kamran Baig,et al.  Applying geo-spatial analysis in community needs assessment: Implications for planning and prioritizing based on data. , 2016, Evaluation and program planning.

[22]  Jacqueline R. Halladay,et al.  Achieving Health Equity: Closing The Gaps In Health Care Disparities, Interventions, And Research. , 2016, Health affairs.

[23]  Cyril F. Chang,et al.  Impact of Medicare Part D on Racial Disparities in Adherence to Cardiovascular Medications Among the Elderly , 2016, Medical care research and review : MCRR.

[24]  K. Wickrama,et al.  Black-White Disparity in Young Adults' Disease Risk: An Investigation of Variation in the Vulnerability of Black Young Adults to Early and Later Adversity. , 2016, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[25]  David R. Williams,et al.  Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health. , 2016, Health affairs.

[26]  A Community Needs Assessment of the Physical Activity and Food Environment in a Predominantly Hispanic U.S. City , 2016, Hispanic health care international : the official journal of the National Association of Hispanic Nurses.

[27]  A. Dalcin,et al.  The Role of Care Management as a Population Health Intervention to Address Disparities and Control Hypertension: A Quasi-Experimental Observational Study. , 2016, Ethnicity & disease.

[28]  D. Levine,et al.  Reaching for Health Equity and Social Justice in Baltimore: The Evolution of an Academic-Community Partnership and Conceptual Framework to Address Hypertension Disparities. , 2016, Ethnicity & disease.

[29]  L. Hayman,et al.  Reducing Disparities in Cardiovascular Health: Social Determinants Matter. , 2016, The Journal of cardiovascular nursing.

[30]  M. Gandhi,et al.  Creating More Effective Mentors: Mentoring the Mentor , 2016, AIDS and Behavior.

[31]  Gregg A. Duncan,et al.  National Heart, Lung, and Blood Institute Workshop Summary: Enhancing Opportunities for Training and Retention of a Diverse Biomedical Workforce. , 2016, Annals of the American Thoracic Society.

[32]  B. Alexander,et al.  Gender differences in developmental programming of cardiovascular diseases. , 2016, Clinical science.

[33]  M. Maria Glymour,et al.  Inequalities in dementia incidence between six racial and ethnic groups over 14 years , 2016, Alzheimer's & Dementia.

[34]  G. V. Van Guilder,et al.  Increased arterial stiffness in South Dakota American Indian children. , 2016, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[35]  M. Schumacher,et al.  Incidence of Dementia over Three Decades in the Framingham Heart Study. , 2016, The New England journal of medicine.

[36]  L. Palinkas,et al.  Measuring sustainment of prevention programs and initiatives: a study protocol , 2015, Implementation Science.

[37]  M. Ogihara,et al.  Automatic classification of communication logs into implementation stages via text analysis , 2015, Implementation Science.

[38]  A. Case,et al.  Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century , 2015, Proceedings of the National Academy of Sciences.

[39]  Kathryn E. Bouskill,et al.  Socioeconomic inequalities in non-communicable diseases and their risk factors: an overview of systematic reviews , 2015, BMC Public Health.

[40]  George Davey-Smith,et al.  Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement From the American Heart Association , 2015, Circulation.

[41]  U. Wilensky,et al.  Computational and technical approaches to improve the implementation of prevention programs , 2015, Implementation Science.

[42]  Association between inter-organizational consensus on use of research evidence and stage of implementation of an evidence-based practice , 2015, Implementation Science.

[43]  G. Mensah,et al.  Reducing racial and ethnic disparities in hypertension prevention and control: what will it take to translate research into practice and policy? , 2015, American Journal of Hypertension.

[44]  A. C. MacKinney,et al.  Characteristics of Rural Accountable Care Organizations (ACOs) – A Survey of Medicare ACOs with Rural Presence. , 2015, Rural policy brief.

[45]  P. Remington,et al.  The County Health Rankings: rationale and methods , 2015, Population Health Metrics.

[46]  C. Lewis,et al.  Race–Ethnic and Sex Differences in Left Ventricular Structure and Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study , 2015, Journal of the American Heart Association.

[47]  Christopher I Amos,et al.  Community-wide cardiovascular disease prevention programs and health outcomes in a rural county, 1970-2010. , 2015, JAMA.

[48]  Jason Madan,et al.  Economic evaluation of the practical approach to lung health and informal provider interventions for improving the detection of tuberculosis and chronic airways disease at primary care level in Malawi: study protocol for cost-effectiveness analysis , 2015, Implementation Science.

[49]  M. Siahpush,et al.  Widening Socioeconomic and Racial Disparities in Cardiovascular Disease Mortality in the United States, 1969-2013 , 2014, International journal of MCH and AIDS.

[50]  M. Siahpush,et al.  Widening Geographical Disparities in Cardiovascular Disease Mortality in the United States, 1969-2011 , 2014, International journal of MCH and AIDS.

[51]  T. Perrino,et al.  Toward Scientific Equity for the Prevention of Depression and Depressive Symptoms in Vulnerable Youth , 2015, Prevention Science.

[52]  M. Pencina,et al.  Predicted long-term cardiovascular risk among young adults in the national longitudinal study of adolescent health. , 2014, American journal of public health.

[53]  Nadine Oosmanally,et al.  Epidemiology and antimicrobial resistance of international travel-associated Campylobacter infections in the United States, 2005-2011. , 2014, American journal of public health.

[54]  Robert N. Anderson,et al.  Potentially Preventable Deaths from the Five Leading Causes of Death — United States, 2008–2010 , 2014, MMWR. Morbidity and mortality weekly report.

[55]  A. Newman,et al.  Effect of socioeconomic disparities on incidence of dementia among biracial older adults: prospective study , 2013, BMJ.

[56]  Arleen F. Brown,et al.  Models of Interinstitutional Partnerships between Research Intensive Universities and Minority Serving Institutions (MSI) across the Clinical Translational Science Award (CTSA) Consortium , 2013, Clinical and translational science.

[57]  A. Clarke,et al.  Thirty Years of Disparities Intervention Research: What Are We Doing to Close Racial and Ethnic Gaps in Health Care? , 2013, Medical care.

[58]  Report of the AACP Task Force on Patient-Centered Medical Homes and Accountable Care Organizations , 2013, American Journal of Pharmaceutical Education.

[59]  C. Murray,et al.  Left behind: widening disparities for males and females in US county life expectancy, 1985–2010 , 2013, Population Health Metrics.

[60]  Sarah J. Flynn,et al.  A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol , 2013, Implementation Science.

[61]  Geoff Sutcliffe,et al.  A Computational Future for Preventing HIV in Minority Communities: How Advanced Technology Can Improve Implementation of Effective Programs , 2013, Journal of acquired immune deficiency syndromes.

[62]  J. Westfall,et al.  Communities of Solution: Partnerships for Population Health , 2013, The Journal of the American Board of Family Medicine.

[63]  S. Woolf,et al.  The US health disadvantage relative to other high-income countries: findings from a National Research Council/Institute of Medicine report. , 2013, JAMA.

[64]  Denis A. Evans,et al.  Psychosocial Distress and Stroke Risk in Older Adults , 2013, Stroke.

[65]  Bryan J Weiner,et al.  The U.S. training institute for dissemination and implementation research in health , 2013, Implementation Science.

[66]  R. McKelvie,et al.  Sex Differences in Clinical Characteristics and Outcomes in Elderly Patients With Heart Failure and Preserved Ejection Fraction: The Irbesartan in Heart Failure With Preserved Ejection Fraction (I-PRESERVE) Trial , 2012, Circulation. Heart failure.

[67]  Sara J. Czaja,et al.  Design and analysis in dissemination and implementation research , 2012 .

[68]  K. Griswold Communities of Solution: The Folsom Report Revisited , 2012, The Annals of Family Medicine.

[69]  Paul Krebs,et al.  Multilevel interventions and racial/ethnic health disparities. , 2012, Journal of the National Cancer Institute. Monographs.

[70]  W. Frontera,et al.  A Multiinstitutional, Multidisciplinary Model for Developing and Teaching Translational Research in Health Disparities , 2012 .

[71]  Mitsunori Ogihara,et al.  Partnerships for the Design, Conduct, and Analysis of Effectiveness, and Implementation Research: Experiences of the Prevention Science and Methodology Group , 2012, Administration and Policy in Mental Health and Mental Health Services Research.

[72]  S. Kellam,et al.  Developing and Maintaining Partnerships as the Foundation of Implementation and Implementation Science: Reflections over a Half Century , 2012, Administration and Policy in Mental Health and Mental Health Services Research.

[73]  W. Frontera,et al.  A Multiinstitutional, Multidisciplinary Model for Developing and Teaching Translational Research in Health Disparities , 2011, Clinical and translational science.

[74]  Lisa Saldana,et al.  Observational measure of implementation progress in community based settings: The Stages of implementation completion (SIC) , 2011, Implementation science : IS.

[75]  Donald M Berwick,et al.  The "Million Hearts" initiative--preventing heart attacks and strokes. , 2011, The New England journal of medicine.

[76]  Andrew C. West,et al.  The Atlanta Clinical and Translational Science Institute , 2011, Clinical and translational science.

[77]  Y. Liao,et al.  Surveillance of health status in minority communities - Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) Risk Factor Survey, United States, 2009. , 2011, Morbidity and mortality weekly report. Surveillance summaries.

[78]  R. Brook,et al.  Accountable care organizations and community empowerment. , 2011, JAMA.

[79]  P. Arguin,et al.  Malaria surveillance--United States, 2009. , 2011, Morbidity and mortality weekly report. Surveillance summaries.

[80]  Is There Progress toward Eliminating Racial/Ethnic Disparities in the Leading Causes of Death? , 2010, Public health reports.

[81]  E. Sondik,et al.  Progress toward the healthy people 2010 goals and objectives. , 2010, Annual review of public health.

[82]  T. Frieden A framework for public health action: the health impact pyramid. , 2010, American journal of public health.

[83]  D. Mozaffarian,et al.  Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction: The American Heart Association's Strategic Impact Goal Through 2020 and Beyond , 2010, Circulation.

[84]  Helen Margellos-Anast,et al.  Black-White health disparities in the United States and Chicago: a 15-year progress analysis. , 2010, American journal of public health.

[85]  T. Holford,et al.  Geographic Variation in One-Year Recurrent Ischemic Stroke Rates for Elderly Medicare Beneficiaries in the USA , 2010, Neuroepidemiology.

[86]  S. Hudak,et al.  Navigating practice and academic change in collaborative partnership with a community advisory board. , 2008, Journal of allied health.

[87]  Harriet Ward,et al.  A Strategy for Assessing Costs of Implementing New Practices in the Child Welfare System: Adapting the English Cost Calculator in the United States , 2010, Administration and Policy in Mental Health and Mental Health Services Research.

[88]  E. Bachman,et al.  A school-based intervention for diabetes risk reduction. , 2010, The New England journal of medicine.

[89]  H. Tiemeier,et al.  Childhood Experiences and the Risk of remature Mortality , 2009 .

[90]  Patti Delger,et al.  Community-Based Participatory Research: A Review of the Literature With Strategies for Community Engagement , 2009, Journal of developmental and behavioral pediatrics : JDBP.

[91]  A. Macaulay,et al.  Practice-based Research is Community Engagement , 2009, The Journal of the American Board of Family Medicine.

[92]  Russell E Glasgow,et al.  Costing Behavioral Interventions: A Practical Guide to Enhance Translation , 2009, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[93]  Amanda M Jovaag,et al.  Ranking community health status to stimulate discussion of local public health issues: the Wisconsin County Health Rankings. , 2008, American journal of public health.

[94]  J. Westfall,et al.  Practice-based research--"Blue Highways" on the NIH roadmap. , 2007, JAMA.

[95]  E. Huang,et al.  Cardiovascular health disparities: a systematic review of health care interventions. , 2007, Medical care research and review : MCRR.

[96]  R. Lilford,et al.  Bmc Medical Research Methodology Open Access the Stepped Wedge Trial Design: a Systematic Review , 2022 .

[97]  Majid Ezzati,et al.  Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States , 2006, PLoS medicine.

[98]  J. Hickner,et al.  A short history of primary care practice-based research networks: from concept to essential research laboratories. , 2006, Journal of the American Board of Family Medicine : JABFM.

[99]  Amy J. Schulz,et al.  Social and Physical Environments and Disparities in Risk for Cardiovascular Disease: The Healthy Environments Partnership Conceptual Model , 2005, Environmental health perspectives.

[100]  Ali H. Mokdad,et al.  State of Disparities in Cardiovascular Health in the United States , 2005, Circulation.

[101]  D. Hale,et al.  Impact of the Bienestar school-based diabetes mellitus prevention program on fasting capillary glucose levels: a randomized controlled trial. , 2004, Archives of pediatrics & adolescent medicine.

[102]  R. Menninger Administration and policy in mental health , 1993, Administration and Policy in Mental Health and Mental Health Services Research.

[103]  K N Lohr,et al.  Community-based participatory research: assessing the evidence. , 2004, Evidence report/technology assessment.

[104]  J. Cutler,et al.  Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. , 2000, Circulation.

[105]  G. Kalton,et al.  Small-area income and poverty estimates : priorities for 2000 and beyond , 2000 .

[106]  D. Barker Fetal origins of cardiovascular disease. , 1999, Annals of medicine.

[107]  B. Israel,et al.  Review of community-based research: assessing partnership approaches to improve public health. , 1998, Annual review of public health.

[108]  D. Altman,et al.  Sustaining interventions in community systems: on the relationship between researchers and communities. , 1995, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[109]  J E Keil,et al.  Socioeconomic factors and cardiovascular disease: a review of the literature. , 1993, Circulation.

[110]  D. Campbell,et al.  Unobtrusive Measures: Nonreactive Research in the Social Sciences , 1966 .