Historically Marginalized and Minority Populations With Pulmonary Arterial Hypertension

TOPIC IMPORTANCE: Pulmonary arterial hypertension (PAH) is a progressive cardiopulmonary disorder with disparities in epidemiologic features, clinical outcomes, and health care access that disproportionately affect historically neglected populations, including Black Americans, Hispanic Americans, and American Indians. REVIEW FINDINGS: This state-of-the-art review examined PAH disparities through cross-cutting themes and population-specific evidence. First, we examined the role of race and ethnicity as social constructs; the historical roots of medical mistrust arising from documented exploitation of Black, Hispanic, and American Indian communities; and the implications of genetic ancestry research within the framework of race as a social, rather than biological, variable. We then reviewed population-specific evidence on clinical phenotypes, survival, and access to care and reviewed the significance of socioeconomic deprivation in clinical outcomes across populations. SUMMARY: This review highlights existing gaps in knowledge and proposes a framework for shared efforts toward the common goal of achieving health equity in pulmonary hypertension care.