Background

According to statistics from the National Institutes of Health (NIH), cardiovascular diseases are the most common cause of morbidity and mortality in the United States, accounting for nearly half of all deaths and health care expenditures. Compared to the rest of the nation, the State of North Carolina ranks high with respect to the magnitude of this problem. In 2000, death rates for cardiovascular disease for all North Carolinians exceeded the national average by 4%, but the rates for minority populations were a staggering 50% higher than the national average (226 vs. 154 per 100,000 populations) with much of the increase attributed to counties in the eastern part of North Carolina. Despite the fact that this situation is not new, physicians do not presently understand the basis of these disparities among minorities. Fortunately, resources are now available to address this problem systematically, including the Human Genome Project and the large sets of genomic, genetic and population information encompassed by that effort.

Against this backdrop, a significant hurdle remains: the lack of sufficiently advanced computer-based information technology to integrate enormous data sets containing tens of thousands of genes and 3 billion units of information per patient, with clinical and population information. This challenge is amplified by the fact that these data sources are not designed to integrate with one another. Unfortunately, traditional funding mechanisms do not exist for the development of the novel information system and operational infrastructure needed for a multidisciplinary approach to this problem.

Program in Racial Disparities and Cardiovascular Disease

The State of North Carolina and the University of North Carolina are uniquely positioned to understand and find solutions to the problem of racial disparities in cardiovascular diseases based on demographic, clinical and scientific resources, resulting in a greater understanding of how racial disparities contribute to differences in wellness, health care needs and outcomes. North Carolina is home to a diverse people including the Lumbee Tribe, the largest Native American population east of the Mississippi, a significant African-American population (21.6% of the state population versus 12.3% nationally) and the fastest growing Latino population in the country, with 400% growth between 1990 and 2000. Of particular relevance to this issue is that Eastern North Carolina African-American individuals living in some counties have a significantly higher than average risk of cardiovascular disease while in other counties the risk is average. Such disparities, even among minority populations, offer insight into the general problem of racial health disparities and its solution.

The University of North Carolina at Chapel Hill, through its nationally recognized Schools of Medicine and Public Health, provides a unique, highly interactive team approach to finding solutions to address racial disparities in cardiovascular disease. The Brody School of Medicine at East Carolina University supports the fastest growing clinical division of cardiology in the region and serves a racially diverse population with a high prevalence of cardiovascular disease and a death rate exceeding the state and national averages. This partnership between UNC-Chapel Hill and East Carolina University, also known as the joint Program in Racial Disparities and Cardiovascular Disease, will enable unprecedented access to diverse cardiovascular patient populations and collaborations among world renowned cardio-thoracic surgeons and cardiologists, as well as scientifically-based data outcomes that do not currently exist.

The Program in Racial Disparities and Cardiovascular Disease will assemble the patient access and computational resources necessary to address the problem of racial disparities in cardiovascular disease. The primary areas of focus of this multidisciplinary effort will be the development of hardware (a state-of-the-art computer database platform); “middleware” (specific computer applications for database communications between different data sets, in collaboration with the IBM Life Sciences Research Division and computer scientists at the ECU School of Computer Science and Technology); technology development (new tools and “rules” that will allow for the integration and mining of genomic data to crack the code of ethnic and racial disparities in cardiovascular diseases; and human resources (physicians, basic scientists, computer scientists, programmers, database managers and population scientists).

While the technology will enable a greater understanding of disease prevalence and targeting, equally important benefits will include improved overall health care and greater access to cardiovascular health care for minorities, and opportunity for economic development in rural, disadvantaged areas. In Fiscal Year (FY) 2005, Congress appropriated $725,000 in Federal funds to help initiate the Program in Racial Disparities. The promise of those funds has already allowed East Carolina University to hire a renowned cardiovascular faculty member for additional work in this field. FY2005 funding and subsequent awards will target congestive heart failure in eastern North Carolina; establish a state-wide congestive heart failure registry and a heart failure education program for primary care doctors. Further, the Program will employ novel information systems to transmit data to the registry at ECU while providing samples for genetic and proteomic analysis from a racially diverse group to project partners at UNC-Chapel Hill. By establishing community-based heart failure clinics, the joint Program can immediately address issues of access, improve the care of patients near their homes, decrease hospitalization, improve mortality, and decrease the cost of care, including a resulting decreased dependence upon Medicaid/Medicare services. It is anticipated that such programs can be generalized to the State and nation as a whole and can also be adapted for other cardiovascular diseases such as stroke, diabetes, hypertension and atherosclerosis.

Action Requested

The North Carolina Congressional Delegation is requested to support additional funding to assemble the computational resources and provider and patient access to address the problem of

racial disparities in cardiovascular disease.

Labor, Health and Human Services and Education FY 2007 Appropriations

Item: Program in Racial Disparities and Cardiovascular Disease

Request: $2,275,000

Agency: Department of Health and Human Services: Centers for Disease Control

Account: Public Health Improvement and Leadership

ECU Office of Federal Relations, 12.05.05