CHICAGO -- Racial and ethnic differences in obesity, high blood pressure and other traits that increase the risk of heart disease are only partly explained by socioeconomic differences, a nationwide study of women found.
Other influences -- ranging from social environment to genes to folk beliefs -- need to be explored in order to devise better strategies for preventing heart disease in minority groups and poor women of all ethnicities, researchers say.
"Both ethnicity and socioeconomic status have important and separate influences on heart-disease risk factors," said the study's lead author, epidemiologist Marilyn A. Winkleby of Stanford University School of Medicine.
Minority women are known to develop heart disease and die from it at higher rates than white women, the authors noted in Wednesday's Journal of the American Medical Association. All subjects were women because they have been studied less than men, Ms. Winkleby said.
Previous research has shown that minority women are more likely to be poor, less educated and have less access to health care.
Research has also shown poor women of all ethnicities and races have more heart-disease-promoting traits -- obesity, hypertension, cigarette smoking, high blood cholesterol, diabetes and a sedentary lifestyle -- than affluent women.
The researchers said they were surprised to find that socioeconomic differences failed to account for most of the differences in heart-disease-promoting traits.
The study involved interviews and medical examinations of more than 5,266 women ages 25 to 64 nationwide from 1988 to 1994, including 1,762 blacks and 1,481 Mexican Americans.
At every socioeconomic level, minority women had significantly more heart-disease-promoting traits than white women, researchers found.
Prevention programs "need to ... tailor strategies to the language and literacy needs, values and cultures of the populations," the researchers said.
Dr. Philip Greenland, a spokesman for the American Heart Association agreed, calling the report a useful contribution.
"We've got to figure out what the right messages are for ethnic minorities. We're not doing it yet," said Greenland, chairman of preventive medicine at Northwestern University Medical School in Chicago.
Greenland noted, for example, that studies show some Hispanic groups have a more fatalistic attitude about their health than non-Hispanics.
A recent study in North Carolina found that superstitions, folk beliefs and religious convictions kept many black women from seeking medical treatment when they discovered breast lumps and may help explain why they are more likely than whites to die of breast cancer.
The beliefs were strongly associated with socioeconomic status but were even more strongly associated with race.