Socioeconomic status may be an uneven predictor of heart health

White adults benefit the most from high socioeconomic status compared to Black, Hispanic and Asian adults in the U.S., finds new study in Journal of the American Heart Association

Research Highlights:

• The benefits of four measures of socioeconomic status (education, income, employment status and health insurance) on ideal heart health were greater for non-Hispanic white adults compared to Black, Hispanic and Asian adults in the U.S.
• The new diverse representative study suggests heart disease prevention efforts should address other non-biological factors that drive cardiovascular health and not rely solely on reducing socioeconomic disparities by race or ethnic group.

Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, Sept. 13, 2023

DALLAS, Sept. 13, 2023 — Improvements in socioeconomic status (education, income, employment status and health insurance) on ideal cardiovascular health may not benefit people from all racial or ethnic groups equally, as white adults were more likely to benefit than Black, Hispanic and Asian adults in the U.S., according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

“The goal of economic interventions and societal policies, such as improving employment, health care access and education, is that they will lead to improvements in health for everyone,” explained senior study author Joshua J. Joseph, M.D., M.P.H., FAHA, an associate professor of internal medicine at The Ohio State University College of Medicine in Columbus. “However, our study found that improvements in these socioeconomic interventions may not benefit people in all racial or ethnic groups equally.”

The researchers suggest that additional factors including psychosocial stress experienced by people in different groups due to racism, medical mistrust and/or unequal access to care, may also drive cardiovascular health inequities.

This study assessed the measures of socioeconomic status with the American Heart Association’s Life’s Essential 8 metrics of ideal heart health across racial and ethnic groups in the United States using the diverse, nationally representative National Health and Nutrition Examination Survey (NHANES 2011-2018) data for about 13,500 adults.

The analysis found that across all participants, higher socioeconomic status was linked with better heart health, as indicated by higher average Life’s Essential 8 scores, which has a 0-100 scale. However, this link was greatest among white adults compared to people in other racial and ethnic groups. For example:

• College education was associated with a 15-point increase in ideal heart health score among white adults, compared to about a 10-point increase in ideal health scores for Black and Hispanic adults and about an 8-point increase among Asian adults.
• Medicaid versus private health insurance was associated with a 13-point decline in Life Essential’s 8 scores among white adults, compared to a 5- to 6-point decline for people in other racial and ethnic groups.

The study had several limitations including that it could not prove cause and effect between socioeconomic status and Life’s Essential 8 score. It also did not include information about the potential effects of wealth or racism over time; data was based on self-reported information; and the study did not differentiate between country of birth or immigration status.

Co-authors and their disclosures are listed in the manuscript. The study was funded in part by The Robert Wood Johnson Foundation and the American Heart Association Strategically Focused Research Network on Biologic Pathways of Chronic Psychosocial Stressors on Cardiovascular Health.

Studies published in the American Heart Association’s scientific journals are peer-reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

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