UNDERSTANDING AND ADDRESSING HEALTH DISPARITIES AMONGST EASTERN FIREFIGHTERS USING CARDIOMETABOLIC RISK SCORES

Abstract

Cardiac events have remained the leading cause of on-duty deaths among US firefighters for the past five decades. PURPOSE: The purpose of this study was to assess the prevalence of cardiometabolic risk (CMR) and examine racial differences between White non-Hispanic and minority firefighters in Eastern North Carolina, specifically the Pitt County area. An adaptation of a predictive CMR model equation was developed to form a composite risk score using data accessible from local firefighters’ annual fitness assessment conducted through East Carolina University’s Cardiovascular Health Assessment Program. By utilizing comprehensive annual fitness assessments, this study aims to address the existing gap in regional data. While research on firefighter health is growing, there is a clear need for more studies focused on the specific population of firefighters in Eastern North Carolina, considering the unique environmental challenges they face. Understanding the impact of cardiometabolic health is crucial for developing effective interventions and improving their overall wellbeing. Eastern North Carolina minority firefighters are expected to have a higher relative risk for cardiovascular disease compared to their White non-Hispanic counterparts. To understand the relationship between cardiometabolic risk (CMR) and sudden cardiac death (SCD), this study examines health disparities faced by firefighters in Eastern North Carolina, with a focus on addressing CMR to better understand the predispositions of SCD. METHODS: 183 career firefighters (38 ± 9 yrs) participated in this study. Group comparisons were made between White non-Hispanic firefighters (n = 150) and minority firefighters (n = 33). CMR composite scores were calculated for firefighters using established cardiometabolic indicators: diagnosed cardiovascular diseases, hypertension medication use, dyslipidemia medication use, diabetes status, tobacco abuse, android gynoid ratio, and metabolic equivalence. An independent samples t-test was conducted to evaluate group differences. RESULTS: The independent samples t-test showed no statistically significant difference in CMR scores between Minority and White non-Hispanic firefighters, t (1.423), p = 0.138, with a negligible effect size (Cohen’s d = 2.21). White non-Hispanic firefighters had a slightly higher mean CMR score (M = 4.21, SD = 2.24) compared to Minority firefighters (M = 3.63 SD = 2.07). Levene’s test confirmed equal variances across groups. CONCLUSION: Contrary to initial predictions, no significant racial differences in CMR were observed among firefighters for the sample population in Eastern North Carolina. Rather, individual health indicators—particularly lipid profiles—emerged as primary contributors to CMR. These findings challenge prior assumptions regarding elevated CMR among minorities, which is a trend often seen in the general population. Future research should investigate protective and occupational factors that may contribute to this pattern and consider intersectional influences such as rank or years of service. These findings challenge prior assumptions regarding elevated CMR among minorities, which is often seen within the general population. Future research should explore protective and occupational factors contributing to this pattern, and consider intersectional influences such as rank, years of service, localized, occupational, and/or behavioral contributions to firefighters’ health risk. Delimitations: This study is delimited to career firefighters employed from Greenville, NC, and the surrounding areas encompassing a small portion of eastern North Carolina. The scope is confined to those who participate in the Cardiovascular Health Assessment Program conducted by East Carolina University’s Human Performance Lab. The risk assessment will encompass specific metrics such as lipid profiles, anthropometric measures, and stress test results. The findings were interpreted under the NFPA Standard 1952 Category B criteria and the guidelines set forth by the American College of Sports Medicine. It is important to note that this study will not assess long-term clinical outcomes beyond the initial assessment, nor will it include data from departments outside the designated geographical region