Historically Marginalized And Minoritized Populations With Pulmonary Arterial Hypertension: A Deeper Dive Into a Complex Question, CHEST July 14, 2026

In pulmonary arterial hypertension there are significant disparities in epidemiology, clinical outcomes, and healthcare access that disproportionately affect historically neglected populations, including Black Americans, Hispanic Americans, and American Indians. A State-of-the-Art review recently published on CHEST examines the disparities in the three groups.

Key points:

Race/ethnicity are social constructs, not biological categories; historical medical exploitation (Tuskegee, forced sterilizations, Henrietta Lacks, boarding schools) explains persistent medical mistrust in these communities
Black Americans: higher CTD/sickle cell-associated pulmonary hypertension; blunted response to endothelin receptor antagonists; survival disparities often tied to insurance access rather than biology
Hispanics: younger, more congenital heart disease-related pulmonary arterial hypertension; highly heterogeneous population; apparent survival advantage disappears after adjusting for age and socioeconomic factors
American Indians: most understudied group; elevated methamphetamine use, scleroderma, and metabolic risk factors; severe underrepresentation in clinical trials (0.3–1%) and limited specialty care access via underfunded Indian Health Service
Socioeconomic deprivation and social determinants of health independently affect pulmonary arterial hypertension outcomes beyond race/ethnicity
Minorities remain significantly underrepresented in pulmonary arterial hypertension clinical trials and registries

Conclusion: These disparities stem from structural/socioeconomic barriers and discrimination—not biological differences. The authors call for greater minority trial inclusion, systematic Social Determinants of Health (SDOH), and community-partnered research to achieve health equity in pulmonary arterial hypertension care.

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