A study published on March 6 in The Lancet Regional Health – Americas highlights a growing divide in cardiovascular health in the United States, underscoring how wealth and education significantly impact the risk of heart disease.
The research, led by Dr. Salma Abdalla, an assistant professor of public health at Washington University in St. Louis, shows that the wealthiest and most educated Americans experience far lower rates of cardiovascular disease compared to the rest of the population—a gap that has widened over the past two decades.
Dr. Abdalla, who began the study at Boston University’s School of Public Health before joining Washington University’s School of Public Health, analyzed data from nearly 50,000 adults who participated in the National Health and Nutrition Examination Survey between 1999 and 2018. The participants were categorized based on their income and education levels. Researchers focused on four major cardiovascular conditions: congestive heart failure, angina, heart attack, and stroke.
The results were stark. Low-income, non-college-educated individuals were found to have significantly higher odds of experiencing these conditions compared to their wealthier, college-educated peers. Specifically, they were 6.34 times more likely to develop congestive heart failure, 2.11 times more likely to experience angina, 2.32 times more likely to suffer a heart attack, and 3.17 times more likely to have a stroke.
Even after accounting for demographic factors and health markers such as body mass index, blood pressure, and cholesterol levels, these disparities remained. The study consistently showed that higher income and education levels were associated with better cardiovascular health outcomes.
The findings suggest that socioeconomic factors, including income and education, play a complex role in determining heart health. Dr. Abdalla noted that while chronic physiological stress due to economic insecurity is a likely contributor, higher-income and better-educated individuals also have better access to health-promoting behaviors, more consistent medical care, and greater support systems. They are also more likely to receive early medical interventions, adhere to prescribed medications, and experience less environmental toxin exposure.
Dr. Abdalla emphasized that addressing cardiovascular disease (CVD) requires more than expanding healthcare access; it necessitates policies aimed at improving long-term access to economic opportunities and education. “We need to dismantle the structural barriers that perpetuate these disparities,” she said.
The study’s senior author, Dr. Sandro Galea, Dean of the School of Public Health at Washington University, highlighted the policy implications of these findings. He stressed that to improve public health outcomes, the U.S. must address the root causes of health disparities—economic opportunity, education, and access to resources that promote long-term health.
This research, funded by The Rockefeller Foundation, was conducted in collaboration with the School of Social and Political Science at the University of Edinburgh and the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital.
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