Ethnic and Socioeconomic Factors as Determinants of Health Status

To the Editor.—To address the racial disparity in cardiovascular disease (CVD), Dr Winkleby and colleagues¹ recommend the need for targeted intervention programs, changes in health policy reforms, and changes in the health care industry. These are indeed important remedies to reduce the growing health status gaps among women and men of color. It is equally important to better understand the role of different life experience as a potential pathway contributing to CVD risk factors among racial and ethnic populations. Winkleby et al report that a higher proportion of African American and Mexican American women lived below the poverty line compared with white women. They also report that African American women (with similar years of age as white women) were more likely to be unmarried and that Mexican American and African American women were also more likely to live in urban areas. Indeed, a higher proportion of Hispanic and African American women do in fact reside in crowded, urbanized settings; a higher proportion of single mothers are also African American.² Economic, time, and residential constraints may therefore partially explain the higher constellation of interrelated primary risk factors observed among women of color in the study by Winkleby et al.