Patient Ethnicity Predicts Poor Health Access and Gaps in Perception of Personal Cardiovascular Risk Factors

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Focus of health literacy campaigns has centered around raising awareness. It is unknown whether awareness of coronary artery disease risk factors accurately reflects personalization of one’s own cardiovascular risk.


A cross-sectional survey was performed in consecutive patients presenting with chest pain admitted to an observation unit of a tertiary care hospital. A 32-item questionnaire in English or Spanish examined knowledge of coronary artery disease risk factors. Separately, the personalization of coronary risk factors was determined by having patients list their individual risk factors for having a heart attack. Primary outcome was the evaluation of ethnic disparities in awareness of cardiovascular risk factors and the patient’s misperceptions on personal risk factors. Secondary outcome was the assessment of access to information in the same population by gender and ethnicity.


Between October 2006 and April 2008, 1584 consecutive patients were screened, and 1051 patients were enrolled. Participants were 57.5% female and 62.8% self-identified White, 22.5% Black, and 11.5% Hispanic. Misperception about personal risk was significantly higher in non-White compared with the White participants for diabetes (in Blacks [odds ratio (OR), 2.22; 95% confidence interval (CI), 1.08–5.57] and Hispanics [OR, 3.50; 95% CI, 1.49–8.20]) and for hyperlipidemia (in Hispanics [OR, 2.21; 95% CI, 1.19–4.10]). Although the majority (85%) had a primary care physician, Blacks and Hispanics were less likely to have access to information (OR, 0.25; 95% CI, 0.10–0.49; and OR, 0.71; 95% CI, 0.37–1.04, respectively).


There are major gaps between awareness and personalization of risk in major modifiable coronary artery disease risk factors in different ethnic groups.

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