Health Equity and Cardiovascular Mortality: The Role of Structural Racism in Persistent Disparities Among Black Americans

Abstract

Cardiovascular disease (CVD) remains the leading cause of mortality in the United States, disproportionately affecting Black Americans. Although lifestyle choices do play a role in cardiovascular disease risk, increasing evidence suggests that long-standing institutional and social inequalities play a large role when it comes to persistent racial disparities in cardiovascular mortality. This review evaluates evidence linking structural racism to cardiovascular health, identifying it as the primary driver of cardiovascular mortality disparities among Black Americans rather than individual behavior. We conducted a narrative review, comparing 12 studies published between November 2020 and January 2026. Selected sources were retrieved from Google Scholar and PubMed/ MEDLINE using keywords such as “Black Americans”, “cardiovascular mortality”, “structural racism”, and “health disparities”. The literature showed that discriminatory housing policies, workplace and residential segregation, unequal healthcare access, and neighborhood conditions aggravate chronic stress, limit health-promoting resources, and increase cardiovascular risk. Together, the specific evidence from the studies points to structural racism as the primary driver of cardiovascular mortality among Black Americans, and that social environmental conditions have a greater influence on cardiovascular disparities than individual behaviors.