Dying Young From Heart Disease: Where You Live in the U.S. Matters
People who live in disadvantaged parts of the United States are nearly twice as likely to die young from heart disease as folks in the wealthiest locales, a new study reports.
In other words, your zip code can tell you as much or more about your heart health risk as your genetic code, said senior researcher Dr. Khurram Nasir, chief of cardiovascular prevention and wellness at Houston Methodist DeBakey Heart and Vascular Center.
The results are even more dire for minorities living in struggling counties, researchers added.
For example, Blacks living in a socially vulnerable county had double the risk of premature death from heart failure, and a 65% higher risk of stroke compared with Blacks living in a prosperous area.
"We found that the U.S. counties that were the worst off from a social vulnerability standpoint had the highest premature cardiovascular mortality," Nasir said. "We're not talking about elderly individuals. We're talking about young individuals who are less than 65."
For this study, Nasir and his team combined data from the U.S. Centers for Disease Control and Prevention to look at places in the United States that are socially vulnerable, and then see how they are affected by heart disease. The results were published Oct. 18 in the journal Circulation.
Factors that create higher levels of social vulnerability include poverty, unemployment, lack of education, single-parent households, disability, minority status, difficulty with English, and types of housing that include apartments and mobile homes.
The people who live in places where these factors are highest tend to be hardest hit by heart problems, researchers found, including:
- a doubled risk of stroke.
- a 2.7 times greater risk of death from high blood pressure.
- a 3.4 times greater risk of heart failure.
- a 52% increased risk of heart disease caused by clogged arteries.
"There is a direct link," Nasir said, adding the worse the vulnerability, the more likely those counties will have premature cardiovascular mortality.
These vulnerable counties also tend to have poorer access to health care and medicines that can control cholesterol and high blood pressure, Nasir said.
People there also aren't as likely to have access to lifestyle factors that can influence heart risk, including healthy foods and safe places for physical activity.
"You're seeing a combination of social, financial and health system factors that have contributed, and no one size fits all," Nasir said. "We'll have to focus on all of them if you truly want to mitigate these social disparities experienced by the unfortunate marginalized communities we're seeing in this data."
There's one silver lining in all this, Nasir added: By using this data, health officials and policy makers can target resources to the communities that need help, and potentially help make a dent in heart disease there.
"These measures need to be incorporated in our planning," Nasir said. "We need to start actively outreaching."
Dr. Elizabeth Jackson, chair of the American Heart Association's committee on social determinants of health, agreed.
"Without access to quality care, nutritious foods, stable housing or other basic health needs, people often get sicker and die younger," said Jackson, interim director of cardiology with the University of Alabama at Birmingham's division of cardiovascular disease.
"Unfortunately, these data are not surprising, but rather support prior evidence suggesting health disparities are disproportionately experienced in areas where higher degrees of social vulnerability exist," Jackson added.
The U.S. Centers for Disease Control and Prevention has more about the social determinants of health.
SOURCES: Khurram Nasir, MD, MPH, chief, cardiovascular prevention and wellness, Houston Methodist DeBakey Heart and Vascular Center, and co-director, Center for Outcomes Research at Houston Methodist; Elizabeth Jackson, MD, MPH, interim director, cardiology, University of Alabama at Birmingham, Division of Cardiovascular Disease; Circulation, Oct. 18, 2021