According to research published recently in Mayo Clinic Proceedings, people living in socially impoverished areas of the United States are more likely to die prematurely from cardiovascular (CV) issues.
Researchers at the Harrington Heart & Vascular Institute at University Hospitals (UH) discovered that social deprivation can explain a considerable amount of the geographic heterogeneity in premature cardiovascular mortality in the United States.
A range of social and economic characteristics, such as education, income, job, and the surrounding environment, are used to characterize socio-economic deprivation. There is a big gap in understanding why there are so many premature CV deaths in the United States that can’t be linked entirely to established risk factors like high cholesterol. According to new research, the socioeconomic disadvantage is a risk factor for this sort of death.
“Socioeconomic status plays a big role in access to preventive care, risk factor control, and incidence of disease,” said Sadeer Al-Kindi, MD, cardiologist and co-director of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) with UH Harrington Heart & Vascular Institute and the study’s senior author.
“UH is committed to improving the health of all people by advancing science and human health. A large part of that is discovering the root cause of disease. With this study, we wanted to determine whether premature cardiovascular mortality is associated with socioeconomic deprivation and how premature cardiovascular mortality changed over time by social deprivation.”
Health and structural inequities in poor communities have been ignored for too long. We now know that where you live, inequities, and other components embedded in the environment are powerful determinants of mortality, often from chronic non-communicable disease. Most importantly, shedding light on this pervasive issue compels us to act upon the information.
Sanjay Rajagopalan
Researchers conducted a cross-sectional examination of United States county-level death certificate data from 1999 to 2018 using files kept by the United States National Center for Health and Statistics in “Socioeconomic Deprivation and Premature Cardiovascular Mortality in the United States.”
They looked at patients who died from cardiovascular diseases between the ages of 25 and 64. They documented two integrated metrics of socioeconomic deprivation using linear regression analysis: the Social Deprivation Index (SDI) and the county Area Deprivation Index (ADI).
According to the findings, counties with high levels of social hardship had the highest incidence of early cardiovascular deaths.
Furthermore, compared to rich counties, premature cardiovascular mortality declined to a smaller amount in socially impoverished counties from 1999 to 2018. In fact, social deprivation variables directly explained a large amount of the geographic disparities in premature CV mortality in the United States.
“Health and structural inequities in poor communities have been ignored for too long. We now know that where you live, inequities, and other components embedded in the environment are powerful determinants of mortality, often from chronic non-communicable disease. Most importantly, shedding light on this pervasive issue compels us to act upon the information,” said Sanjay Rajagopalan, MD, Chief of Cardiovascular Medicine and Chief Academic and Scientific Officer of UH Harrington Heart & Vascular Institute and co-author of the study, as well as the Herman K. Hellerstein, MD, Chair in Cardiovascular Research.
UH is making a difference in a variety of ways, including through its community service through the ACHIEVE GreatER project. Medical and cardiovascular care will be offered directly to persons living in Cuyahoga Metropolitan Housing Authority, one of the nation’s largest and oldest subsidized housing programs, thanks to a “transformative” $18.2 million government funding from the National Institutes of Health’s P50 program.
The study team is also working to understand the social and environmental causes of early cardiovascular disease in Northeast Ohio and across the country.
“Regardless of where they live or how much money they make, all people should have the opportunity to receive the necessary medical resources and support to have a healthier life,” said Dr. Mehdi Shishehbor, DO, MPH, Ph.D., President of UH Harrington Heart & Vascular Institute, and the Angela and James Hambrick Chair in Innovation.
Previous research has looked into the link between race and CV mortality, as well as the link between individual socioeconomic characteristics (income, high school education) and CV mortality.
“To our knowledge, this is the first study to demonstrate a longitudinal association between multiple integrated metrics of socioeconomic deprivation and premature cardiovascular mortality adjusted for traditional cardiovascular risk factors, while also showing potentially worsening disparities,” said Dr. Al-Kindi.
