Among African American adults with low education and income levels, the increase in risk of heart disease or stroke associated with living in poverty is largest for women and people under age 50, according to a large new study.
In the Mississippi African American population studied, women with the lowest “socioeconomic position“ were more than twice as likely to have heart disease or stroke as those with the highest socioeconomic position.
The effect was also greatest among younger adults, with low-income men and women under age 50 more than three times as likely to experience cardiovascular problems compared to peers with the highest socioeconomic status, according to lead author Samson Y. Gebreab of the National Human Genome Research Institute at the National Institutes of Health in Bethesda, Maryland.
“African Americans with low SES (socioeconomic status) are more likely to have higher rates of obesity, hypertension, type 2 diabetes and physical inactivity compared to their counterparts of higher SES,” Gebreab told Reuters Health by email.
These risk factors partly, but not entirely, explained the higher risk of heart disease in African American women of low socioeconomic status, he said.
“Another possible explanation is that African American women of low SES experience higher rates of psychosocial stressors such as chronic stress, depression, discrimination and are more likely to live and work in a worse physical and social environment,” he said.
Having far fewer resources at their disposal to cope with these stressors creates a recipe for a higher risk of heart attack and stroke in African American women of lower SES, Gebreab said.
The researchers used a previous long-term study of 5,301 African Americans ages 21 to 94, most of whom were women. Half were followed for more than seven years. Over that time, there were 362 cases of cardiovascular events like heart attack or stroke.
Using in-person and telephone interviews, researchers collected data on participants’ socioeconomic position in childhood, based on parental home ownership, mother’s education level and available amenities. Questions about current education, wealth, income and public assistance were used to estimate each person’s adult socioeconomic position.
Adult socioeconomic position was more strongly tied to heart disease and stroke risk than childhood position, as reported in a paper scheduled for publication in the Journal of the American Heart Association.
Wealth was a more important predictor of heart risk than education level or public assistance. And men showed a similar, but smaller increase in risk with lower socioeconomic position.
After age 50, the risk increase specifically linked to socioeconomic position was also smaller, which may be a result of more widespread heart disease in older groups – weakening the links to socioeconomic position alone.
The study team notes that participants with higher adult socioeconomic position were less likely to smoke or drink and tended to have better quality diets and higher levels of physical activity, with lower body mass index and blood pressure and fewer cases of high blood pressure or diabetes compared to the low-socioeconomic status group.
“Although we have not accounted for health care access in our study, these (low SES) groups of people often also have less access to health care and encounter barriers to CVD (cardiovascular disease) related diagnosis and treatment,” Gebreab said.
Other research suggests that African Americans of any socioeconomic status may be at higher risk for heart disease or stroke than others, according to Maria Glymour of the epidemiology and biostatistics department at the University of California, San Francisco.
“We all need resources and supports to help us stay healthy, like a safe place to exercise, an affordable grocery store, time to do whatever is needed to take care of our health, and attentive medical care for managing diseases such as hypertension,” she told Reuters Health by email. “Low SES people on average simply have fewer of these resources.”
Low SES is also tied to higher risk of cardiovascular disease among white people, noted Glymour, who was not involved in the new study.
“People with low SES, particularly African American women, should be considered as a high-risk group for developing CVD, as such they should be considered as priority in health care services,” Gebreab said. “They should be targeted for early detection and intervention for the prevention of CVD and related risk factors.”
But there is no “magic bullet” solution to reduce heart health disparities based on socioeconomic status, he said.