Is financial status the key to a healthy heart?
During an American Heart Association meeting in 2009, research teams presented staggering results concerning a deadly yet prevalent chronic disease. Cardiovascular disease (CVD) encompasses various conditions related to the heart or blood vessels. Egyptian researchers found evidence of coronary artery disease (narrowing of the arteries) in mummies almost 3,500 years old. This ancient disease is the number one killer in the US, causing nearly 655,000 deaths annually. Despite its long history, heart disease remains one of the top five most preventable diseases, often resulting from unhealthy habits such as poor diet, inactivity, alcohol consumption, and smoking. In addition to these behavioral risk factors, socioeconomic factors, family household income, and employment status are also associated with CVD.
It has become apparent that socioeconomically disadvantaged groups are more likely to be exposed to common risk factors for CVD. The disparities in cardiovascular disease reflect widespread inequities in health and socioeconomic status (SES), with less attention given to the growing health disparities between the rich and poor.
Socioeconomic status refers to an individual’s income, education, and occupation. Those with low wealth or income primarily live in neighborhoods with others in similar economic situations. These socioeconomically disadvantaged groups often exhibit adverse health behaviors, such as smoking, low physical activity, sedentary lifestyles, and drug abuse.
A 2015 study of 1.3 million low SES adults aged 35 and older found that 19% were more likely to develop coronary heart disease.
Smoking is a traditional risk factor that can cause many heart diseases, including blood clots, plaque formation, increased blood pressure, stroke, irregular heart rhythm, and tightened arteries. Low SES groups are often targeted by tobacco marketers, have easier access to cigarettes, and receive less support for quitting smoking.
Physical inactivity is another significant concern. Many Americans report less than the average physical activity needed to meet public health guidelines. Leisure-time physical activity (LTPA), such as sports, walking, at-home exercises, yard work, and biking, is essential for maintaining heart health. Nearly 25% of adults do not participate in any LTPA, and this number is steadily increasing. Families with demanding jobs and low SES struggle to find time for physical activity due to long working hours and childcare responsibilities. Regular physical activity is crucial for reducing cholesterol buildup in the arteries and preventing cardiac issues like high blood pressure, elevated cholesterol, metabolic syndrome, clogged arteries, abnormal heart rhythm, Marfan syndrome, and heart failure.
Many organizations, research centers, and prevention programs are dedicated to combating cardiovascular disease. However, the widespread health inequities between low and high-income patients remain a pressing issue. Studies have shown that physicians often have biased perceptions of low SES patients, affecting clinical decisions. Low SES patients receive fewer referrals for special care, necessary medications, and diagnostic evaluations. They also have longer waiting times for non-emergency procedures and receive limited check-ups and inadequate care, exacerbating their condition. A study of nearly 90,000 individuals in Australia and New Zealand found that those with lower socioeconomic status had an increased risk of CVD compared to those with higher education.
To prevent these disparities, we must address health inequities in policies and programs. Public health programs should highlight issues not covered in the media by directly interviewing patients. The welfare of our society depends on policy changes and health activists addressing these deeply rooted inequities and social determinants.
Although health appears to be determined by genetics, lifestyle, and environment, there is a complex set of factors influencing physical well-being. Socioeconomically disadvantaged groups often engage in adverse behaviors, increasing their risk of CVD. Inadequate healthcare for low SES individuals leads to worsening conditions. Understanding the causes of healthcare disparities will enable us to take viable steps toward health equity, saving millions of hearts at risk.
