A recent study led by Salma Abdalla, an assistant professor of public health at Washington University in St. Louis, reveals a concerning rise in cardiovascular health disparities across the U.S. The research shows that the top 20% of high-income, college-educated Americans are experiencing significantly lower rates of cardiovascular disease (CVD) compared to the rest of the population. This gap has notably widened over the past two decades.
CVD remains the leading cause of death and illness in the U.S., but the new findings underscore the increasingly unequal burden of this health condition. The wealthiest Americans—those with higher income and education—continue to enjoy better heart health outcomes, while the majority of the population, particularly those with lower incomes and less education, face significantly higher risks of heart disease.
Despite the U.S. spending more on healthcare than any other high-income nation, outcomes for the broader population continue to lag, especially for individuals from lower socio-economic backgrounds. Life expectancy for the wealthiest 1% is now 10 years higher than for the poorest 1%. These trends have worsened in comparison to other high-income countries.
The study analyzed two decades of data from nearly 50,000 adults who participated in the National Health and Nutrition Examination Survey (1999-2018), focusing on the prevalence of key cardiovascular conditions such as heart failure, angina, heart attack, and stroke. Researchers categorized participants by income and education and discovered that lower-income, non-college-educated individuals faced significantly higher odds of these conditions compared to their wealthier, more educated peers. Specifically, they had 6.34 times the odds of congestive heart failure, 2.11 times the odds of angina, 2.32 times the odds of heart attack, and 3.17 times the odds of stroke.
Even after accounting for factors like body mass index, cholesterol levels, and blood pressure, the disparities remained. The data suggests that income and education play a pivotal role in heart health, with higher socio-economic status consistently linked to better cardiovascular outcomes.
The study highlights the need for further research into the complex relationship between income, education, and heart health. It points to various factors such as chronic stress due to economic insecurity, access to healthier lifestyle options, and better medical care as contributors to these disparities. High-income and educated individuals are more likely to receive preventive care, adhere to medications, and live in environments with lower exposure to toxins.
Abdalla emphasizes that improving heart health outcomes requires more than just expanding healthcare access. It demands long-term policies that focus on economic opportunity and educational equity. “Wealth and education cluster among a small, advantaged group, while the majority of Americans face an increased risk of heart disease,” she says.
Sandro Galea, senior author of the study and Dean of the School of Public Health, stresses the importance of addressing the underlying social determinants of health. “To improve public health outcomes, we must tackle the root causes—economic opportunity, education, and access to resources that foster long-term health,” Galea states.
This research, funded by The Rockefeller Foundation, underscores the urgency of addressing these widening health disparities. It highlights the critical need for structural changes that ensure all Americans have the opportunity to achieve better health, particularly in the face of growing economic inequalities.
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