Global study shows racialized, Indigenous communities face higher burden of heart disease made worse by data gaps

A new study has revealed that racialized and Indigenous communities across Europe, North America, and Central America face significantly higher rates of cardiovascular disease (CVD), and that gaps in health care data are making the problem worse.

CVD is the leading cause of death worldwide but does not affect people equally. In many countries, Black, South Asian and Indigenous peoples have higher rates of heart disease, diabetes, or high blood pressure compared to white populations. Without an understanding of who is most at risk and why, health systems are unprepared to provide fair and effective care.

The research, published in The Lancet Regional Health-Europe, is co-authored by two McMaster University scientists as part of a commission on inequalities and disparities in cardiovascular health, announced in June 2024. The findings will be presented at the European Society of Cardiology’s (ESC) Congress 2025 in Madrid on August 29.

“The novelty of this research lies in the comprehensive, cross-regional evidence showing that these disparities are not random; they’re deeply tied to social disadvantages such as poverty, poor housing, and limited access to care. The findings show women from marginalized communities are especially affected,” says Sonia Anand, lead author of the research and a professor in the Department of Medicine at McMaster. Anand is associate vice president of Global Health and the inaugural leader of the Mary Heersink School of Global Health and Social Medicine at McMaster.

A key issue highlighted by the study is the inconsistent collection and reporting of racial data in health care systems globally. This gap limits the ability to identify high-risk groups for CVD, tailor prevention and treatment, and design policies that address the risk.

• In Canada, ethnicity is collected in the census but not in health care administrative databases, making it difficult to track disparities in real-time clinical settings.
• In Europe, most countries lack standardized ethnicity data in health care. Proxy measures like country of birth are used, which are inadequate for understanding health risks.
• In Mexico, Central America, and the Caribbean, ethnicity and race data are rarely collected, and Indigenous health data is especially sparse.
• In the United States, race and ethnicity are collected more consistently, but the categories are not granular enough, especially within diverse groups like Asian Americans.

“This research highlights a critical blind spot in global health systems: without accurate data on race and ethnicity, inequalities in heart health remain hidden and unaddressed,” says Sujane Kandasamy, co-author on the study and an assistant professor in the Department of Medicine at McMaster.

The study has a special section devoted to Indigenous populations in each global region, and showed that Indigenous peoples, irrespective of region, continue to be affected by marginalization and other impacts of colonialism that have disrupted their traditional, healthy lifestyles. The section, led by co-author Miles Marchand, an Indigenous cardiologist from the University of British Columbia, showed populations of Indigenous peoples who have maintained or restored their traditional lifestyles displayed improved cardiovascular health irrespective of the barriers to care they face.

The authors say the research provides a roadmap for fairer, more effective care and policy, with the potential to save lives and reduce health care costs. Among their recommendations are for governments to monitor trends in cardiovascular health with self-reported data, for clinicians to screen high-risk communities, and for public health programs to provide low-cost treatments and encourage active lifestyles and culturally tailored healthy eating.

A new study has revealed that racialized and Indigenous communities across Europe, North America, and Central America face significantly higher rates of cardiovascular disease (CVD), and that gaps in health care data are making the problem worse.

CVD is the leading cause of death worldwide but does not affect people equally. In many countries, Black, South Asian and Indigenous peoples have higher rates of heart disease, diabetes, or high blood pressure compared to white populations. Without an understanding of who is most at risk and why, health systems are unprepared to provide fair and effective care.

The research, published in The Lancet Regional Health-Europe, is co-authored by two McMaster University scientists as part of a commission on inequalities and disparities in cardiovascular health, announced in June 2024. The findings will be presented at the European Society of Cardiology’s (ESC) Congress 2025 in Madrid on August 29.

“The novelty of this research lies in the comprehensive, cross-regional evidence showing that these disparities are not random; they’re deeply tied to social disadvantages such as poverty, poor housing, and limited access to care. The findings show women from marginalized communities are especially affected,” says Sonia Anand, lead author of the research and a professor in the Department of Medicine at McMaster. Anand is associate vice president of Global Health and the inaugural leader of the Mary Heersink School of Global Health and Social Medicine at McMaster.

A key issue highlighted by the study is the inconsistent collection and reporting of racial data in health care systems globally. This gap limits the ability to identify high-risk groups for CVD, tailor prevention and treatment, and design policies that address the risk.

• In Canada, ethnicity is collected in the census but not in health care administrative databases, making it difficult to track disparities in real-time clinical settings.
• In Europe, most countries lack standardized ethnicity data in health care. Proxy measures like country of birth are used, which are inadequate for understanding health risks.
• In Mexico, Central America, and the Caribbean, ethnicity and race data are rarely collected, and Indigenous health data is especially sparse.
• In the United States, race and ethnicity are collected more consistently, but the categories are not granular enough, especially within diverse groups like Asian Americans.

“This research highlights a critical blind spot in global health systems: without accurate data on race and ethnicity, inequalities in heart health remain hidden and unaddressed,” says Sujane Kandasamy, co-author on the study and an assistant professor in the Department of Medicine at McMaster.

The study has a special section devoted to Indigenous populations in each global region, and showed that Indigenous peoples, irrespective of region, continue to be affected by marginalization and other impacts of colonialism that have disrupted their traditional, healthy lifestyles. The section, led by co-author Miles Marchand, an Indigenous cardiologist from the University of British Columbia, showed populations of Indigenous peoples who have maintained or restored their traditional lifestyles displayed improved cardiovascular health irrespective of the barriers to care they face.

The authors say the research provides a roadmap for fairer, more effective care and policy, with the potential to save lives and reduce health care costs. Among their recommendations are for governments to monitor trends in cardiovascular health with self-reported data, for clinicians to screen high-risk communities, and for public health programs to provide low-cost treatments and encourage active lifestyles and culturally tailored healthy eating.