Lower income US adults were left behind as the rest of the United States experienced large declines in heart attack and stroke risk over three decades
Over the last three decades, heart disease deaths have plummeted in the US, but a new study suggests cardiovascular benefits apply only to people in higher income populations. For poor populations, heart attack rates stayed the same or got worse during that 30-year period.
Adam Richards, George Washington University associate professor of global health and medicine, and his colleagues evaluated data from national surveys of nearly 27,000 people aged 40 to 75 years old who had not experienced a prior heart attack or stroke. They calculated the estimated 10-year risk of cardiovascular disease for each six-year period of the study. Without factoring in income, national level trends show improvement in cardiovascular disease from 1988 to 2018.
However, when the researchers explored the distribution of these changes according to household income they found much of the heart healthy benefits were not experienced equally among members of society. Although the 10-year cardiovascular risk fell from 7.7% to 5.1% for the wealthiest segment of the population and from 7.6% to 6.1% for the second-wealthiest group, cardiovascular risk for people with the lowest incomes remained stagnant at over 8%.
This study was not designed to look for the underlying reasons behind the inequities, but other research demonstrates that improvements in treatments and improved risk factor control each explain approximately half the decline in cardiovascular mortality over this period, and that it is likely the case that differential trends in treatment access and risk factors contribute to the widening of income-related inequalities.
The study, Trends in Income Inequities in Cardiovascular Health among US Adults, 1988–2018, was published April 3, 2024 in the journal Circulation: Cardiovascular Quality and Outcomes.
