We read with interest the paper by Ullah and Tamanna (January 2023) [1], examining racial disparities in cardiovascular outcomes associated with obstructive sleep apnea.
The authors state their aim to “tease apart how much of the propensity of these health complications are attributable to the race/ethnicity itself.” However, because race is a social construct and not a genetic or inherent biologic one, associations between racial category and outcomes are overwhelmingly explained by social determinants [2,3]. The article admits that the only SES adjustment was for education, therefore any association between the ‘racial category’ variable and outcomes was likely confounded by other known causal mechanisms such as poverty, segregation, food insecurity, neighborhood deprivation, or others [2].
We are also concerned that the authors do not name systemic or structural racism as the root cause of inequities in cardiovascular outcomes [3,4]. While the word ‘race’ or ‘racial’ is used 30 times, and ‘genetic’ four times, the word “racism” is not found in the text [1].
The fact that race is a social construct is important when evaluating the authors’ claim that “Socioeconomic conditions as well as genetic factors are believed to be two of the most important components behind” health disparities. Without presenting genetic data, conclusions about genetics are conjecture. In fact, when the authors propose that “genetic risk scoring … has been shown to be associated with incident CVD and its effect is higher in AAs” [1] the authors cite two references that do not support their claim, but contradict it. One of the references even concludes that “the accumulated evidence for a genetic contribution to CVD disparities in blacks versus whites has been essentially nil.” [5].
It is important to find racial disparities, but when they are found, we must first ask how racism created the disparities before speculating upon unsubstantiated causal pathways such as genetics.
Footnotes
Declaration of competing interest
We have no disclosures and no potential conflict of interest relevant to this letter to report.
Contributor Information
Francois G. Rollin, Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Kara J. Mould, Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Daniel Colon Hidalgo, Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
References
- [1].Ullah MI, Tamanna S. Racial disparity in cardiovascular morbidity and mortality associated with obstructive sleep apnea: the sleep heart health study. Sleep Med 2023. Jan;101:528–34. [DOI] [PubMed] [Google Scholar]
- [2].Beech BM, Ford C, Thorpe RJ Jr, et al. Poverty, racism, and the public health crisis in America. Front Public Health 2021. Sep 6;9:699049. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Breathett K, Spatz ES, Kramer DB, et al. The groundwater of racial and ethnic disparities research. Circulation: Cardiovascular Quality and Outcomes 2021;14(2). [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Bailey ZD, Feldman JM, Bassett MT. How structural racism works-racist policies as a root cause of U.S. Racial health inequities. N Engl J Med 2021. Feb 25;384(8):768–73. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Kaufman JS, Dolman L, Rushani D, Cooper RS. The contribution of genomic research to explaining racial disparities in cardiovascular disease: a systematic review. Am J Epidemiol 2015. Apr 1;181(7):464–72. [DOI] [PubMed] [Google Scholar]