New research from Michigan Public Health

November 7, 2022

Biases in heart disease and metabolic disorder—also known as cardiometabolic—studies
are putting the lives of midlife Black and Hispanic women in jeopardy.

These women are experiencing cardiometabolic risks five to 11 years earlier than White
women, but studies designed to gauge these differences often underestimate the disparity,
according to new research from the University of Michigan. 

In a new study published in JAMA Network Open, researchers corrected for the sources of systematic exclusion common in studies
and learned that correction for these biases decreased the estimated age of cardiometabolic
disease onset by an average of 20 years.

“Black and Hispanic women were most affected by these biases,” said the study’s lead
author Alexis Reeves, a former doctoral student in Epidemiology at the University
of Michigan School of Public Health.

Earlier disease onset for minority populations points to “weathering” or earlier health
declines in these groups due to structural social and economic marginalization. Given
that cardiometabolic diseases are the main predictor of health and longevity, understanding
these racial differences in “weathering” and the typical age of onset of the disease
is important to target interventions to earlier stages of life for prevention, noted
senior author Sioban Harlow, professor of Epidemiology at Michigan Public Health.

Data are from a cohort study that followed midlife women from 1996 to 2016. The study
involved more than 3,300 women aged 42 to 52 years in 1996,  whose racial or ethnic
group included Black, Chinese, Hispanic, Japanese, and white women.

The findings indicated that hypertension occurred about 5 years earlier and  insulin
resistance and diabetes 11 years earlier for minority women than their white counterparts.

“Failure to account for selection biases… was associated with falsely high estimates
of age at cardiometabolic onset, with greater misestimation among Black and Hispanic
women,” said Reeves, who is currently a post-doctoral fellow at Stanford School of
Medicine.

In other words, interventions should be targeted to minority women as young as 30
years for hypertension and 40 years for metabolic conditions, the researchers said.
If not addressed, cardiometabolic disease will shorten a person’s life span.

Also, the researchers noted the study had limited power for estimating age of onset
for Chinese and Japanese women, as they had a low prevalence and incidence of metabolic
outcomes in the study. 

The study highlights important and understudied biases in observational research,
Reeves said. It suggests the need for more careful consideration of these biases in
new and ongoing research on the causes and prevention of earlier aging and health
declines for minority populations, she said. 

The study’s other authors are Michael Elliott, professor of Biostatistics Michigan Public Health; Tene Lewis, associate professor
of Epidemiology at Emory University; Carrie Karvonen-Gutierrez, assistant professor of Epidemiology at Michigan Public Health; and William Herman, professor of Epidemiology and Internal Medicine at the University of Michigan. 

Contact

Destiny Cook

Public Relations Specialist

University of Michigan School of Public Health

734-647-8650

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