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- ↵∗National Clinician Scholars Program, Yale School of Medicine, P.O. Box 208088, New Haven, Connecticut 06520
I read with interest the recent paper by Deo et al. (1), which investigated differences in sudden cardiac death (SCD) risk between blacks and whites. The authors demonstrate that in a large cohort, after hierarchical adjustment for a number of risk factors, blacks have a 2-fold higher risk of SCD than whites.
I was dismayed, however, to read their conclusion that “racial differences in the underlying pathophysiology of SCD” may explain this difference in risk, which persists even “after controlling for sociodemographic and cardiovascular risk factors.” The implication is that blacks may possess an “underlying susceptibility to fatal arrhythmias” (1).
Our understanding of human genetics does not support this notion. Race is a complex, socially-constructed phenomenon encompassing an individual’s experience across the life course. It is not based in any essential quality specific to 1 group (2). Even in those cases where black ancestry-related gene variants have been associated with disease (e.g., APOL1, where certain variants are over-represented among persons of African descent), their absolute contribution to excess mortality is small (3).
The authors do acknowledge the possibility of residual confounding, especially relating to covariates of education and income. Education and income variables, as they are often interpreted in published health disparities data, are at best weak proxies for what they purport to measure—in the case of blacks in the United States, the sequelae of historically rooted structural racism (4).
The authors rightly call for additional research into racial differences in SCD risk. But it is inaccurate to conjecture that these differences are due to some underlying racial predisposition. To do so is to elide the larger-scale, societal causes of black-white health disparities in the United States while reifying the pernicious idea that people can be placed into biologically distinct categories.
Please note: Dr. Pendyal has reported that he has no relationships relevant to the contents of this paper to disclose.
- 2019 American College of Cardiology Foundation
- Deo R.,
- Safford M.M.,
- Khodneva Y.A.,
- et al.
- Cooper R.S.,
- Nadkarni G.N.,
- Ogedegbe G.
- Kaufman J.S.,
- Rushani D.,
- Cooper R.S.