Women who live in socially disadvantaged neighbourhoods may face poorer heart health for decades and experience a faster decline as they approach menopause, according to a long-term study led by the Harvard Pilgrim Health Care Institute. The findings suggest that where women live can have a lasting influence on cardiovascular health beyond individual lifestyle choices.
Researchers tracked more than 1,200 women in eastern Massachusetts for over 20 years, following them from pregnancy into midlife. Published in Circulation: Population Health and Outcomes, the study assessed heart health at five different time points using a score based on eight measures, including blood pressure, cholesterol, diet, sleep, physical activity, and other key health factors.
Women living in the most socially vulnerable neighbourhoods consistently recorded heart health scores around 6 to 10 points lower than those living in the least disadvantaged areas. These differences appeared within three years of joining the study and remained evident throughout more than two decades of follow-up. Participants in disadvantaged neighbourhoods also experienced a steeper decline in heart health before menopause, a stage of life when cardiovascular risk naturally begins to rise.
Individual socioeconomic factors also influenced outcomes. Women with lower incomes, lower educational attainment, or who identified as Non-Hispanic Black generally had lower heart health scores throughout the study, highlighting the combined effects of personal and community-level circumstances on long-term cardiovascular wellbeing.
Heart disease remains the leading cause of death among women, making these findings particularly significant. Previous research has shown that even modest reductions in heart health scores are linked to a greater risk of cardiovascular disease and premature death, suggesting that relatively small differences can have important long-term consequences.
“Our study shows that heart health in midlife is shaped by more than personal choices,” said senior author Izzuddin Aris, associate professor at Harvard Medical School and the Harvard Pilgrim Health Care Institute. “Income, education, and neighbourhood conditions may all play a role.” Researchers also found that neighbourhood disadvantage continued to affect heart health even after accounting for income and education, indicating that long-term exposure to under-resourced communities has an independent impact on cardiovascular health.
Aris added that the years leading up to and surrounding menopause may represent a critical opportunity to improve women’s cardiovascular health. He noted that targeted support could be especially beneficial for women living in neighbourhoods with fewer resources, where persistent social and environmental challenges may contribute to worsening heart health over time.
The researchers say the findings highlight the importance of improving access to healthy food, safe places for physical activity, and quality healthcare in disadvantaged communities. The study drew on data from Project Viva. This ongoing research programme has followed women from pregnancy in the early 2000s into midlife, providing a rare long-term view of how neighbourhood environments can shape heart health across decades.
More information: Zhi Lin et al, Associations of Sociodemographic and Neighborhood Vulnerability With Cardiovascular Health in Midlife Women in the United States, Circulation. DOI: 10.1161/CIRCOUTCOMES.126.013433
Journal information: Circulation Provided by Harvard Pilgrim Health Care Institute
