Over the past three decades, while heart disease mortality has sharply decreased across the United States, a recent study highlights that these cardiovascular benefits have predominantly benefited higher-income groups. Among lower-income communities, there has been little to no improvement in heart attack rates, with some instances worsening over the 30 years.
Adam Richards, an associate professor of global health and medicine at George Washington University, pointed out that the improvements in cardiovascular health have not been uniformly distributed. “The past thirty years have shown an unequal decline in cardiovascular health, necessitating a closer examination of healthcare accessibility and other social determinants of health that disproportionately impact cardiovascular risks in low-income families,” Richards explained.
Richards and his team analysed data from national surveys involving nearly 27,000 individuals aged between 40 and 75 who had no history of heart attacks or strokes. They assessed the estimated 10-year risk of cardiovascular disease for each six-year study segment. Initially disregarding income, the overall national data from 1988 to 2018 indicated improvements in cardiovascular disease rates.
However, when income was considered, disparities became evident. While the wealthiest portion of the population saw their 10-year cardiovascular risk decrease from 7.7% to 5.1%, and the second wealthiest group experienced a reduction from 7.6% to 6.1%, the risk for the lowest income group remained consistently high, above 8%.
The scope of the study should have included investigating the root causes of these disparities. Nonetheless, other studies suggest that about half of the reduction in cardiovascular mortality can be attributed to better treatments and risk factor management, with disparities in treatment accessibility and risk factor prevalence likely contributing to the growing socioeconomic inequalities in health.
Richards also noted that the U.S., unique among high-income nations, lacks a universal health insurance system, placing significant obstacles in the path of low-income individuals, even those insured. These barriers include financial constraints and difficulties related to transportation. He highlighted the broader socioeconomic influences, such as income and social status, significantly shaping health outcomes. In the U.S., issues like tobacco use, obesity, and diabetes are increasingly concentrated among low-income populations. Compared to other developed nations, the U.S. invests less in social health determinants, such as paid childcare, medical leave, and nutritional support, which can mitigate the health impacts of poverty.
This comes in a context where, according to the American Heart Association, heart attacks and strokes have been the leading causes of death in the U.S. for over a century.
More information: Nicholas K. Brownell et al, Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988–2018, Circulation Cardiovascular Quality and Outcomes. DOI: 10.1161/CIRCOUTCOMES.123.010111
Journal information: Circulation Cardiovascular Quality and Outcomes Provided by The George Washington University
