Family income and cardiovascular disease risk in American adults

Abstract

Socioeconomic status is an overlooked risk factor for cardiovascular disease (CVD). Low family income is a measure of socioeconomic status and may portend greater CVD risk. Therefore, we assessed the association of family income with cardiovascular risk factor and disease burden in American adults. This retrospective analysis included data from participants aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) cycles between 2005 and 2018. Family income to poverty ratio (PIR) was calculated by dividing family (or individual) income by poverty guidelines specific to the survey year and used as a measure of socioeconomic status. The association of PIR with the presence of cardiovascular risk factors and CVD as well as cardiac mortality and all-cause mortality was examined. We included 35,932 unweighted participants corresponding to 207,073,472 weighted, nationally representative participants. Participants with lower PIR were often female and more likely to belong to race/ethnic minorities (non-Hispanic Black, Mexican American, other Hispanic). In addition, they were less likely to be married/living with a partner, to attain college graduation or higher, or to have health insurance. In adjusted analyses, the prevalence odds of diabetes mellitus, hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke largely decreased in a step-wise manner from highest (≥ 5) to lowest PIR (< 1). In adjusted analysis, we also noted a mostly dose-dependent association of PIR with the risk of all-cause and cardiac mortality during a mean 5.7 and 5.8 years of follow up, respectively. Our study demonstrates a largely dose-dependent association of PIR with hypertension, diabetes mellitus, CHF, CAD and stroke prevalence as well as incident all-cause mortality and cardiac mortality in a nationally representative sample of American adults. Public policy efforts should be directed to alleviate these disparities to help improve cardiovascular outcomes in vulnerable groups with low family income.

Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions

“…A recent NHANES analysis of poverty by family income and socioeconomic status (SES) showed an association with being a female, a racial/ethnic minority member, single, without a college degree, and without health insurance. Lower SES increased the risk of hypertension, cardiovascular morbidity and mortality, and all-cause mortality [15]. Discrimination, a known source of stress, may increase hypertension, suggesting future studies should explore the impact of long-standing, structural inequities on hypertension risk.…”

Experiences of poverty amongst low‐income older adults living in a high‐income country: A qualitative study

“…Living in poverty negatively impacts cognitive and socioemotional processes commonly associated with healthy aging and it is considered a determining factor for social exclusion (Niedzwiedz et al, 2016) as it leads to inequalities and barriers to accessing public services (Price et al, 2018). Living in poverty has been associated with malnutrition (Dufe Turkson et al, 2022), greater functional limitation (Boggatz et al, 2010), higher mortality rates and an increased number and duration of hospital readmissions (Landon et al, 2023; Minhas et al, 2023). Living in poverty can also increase the prevalence of multiple chronic conditions (Choi et al, 2020; Minhas et al, 2023; Mira et al, 2023) and antibiotic prescribing rates (Tarkhashvili, 2023).…”

“…Living in poverty has been associated with malnutrition (Dufe Turkson et al, 2022), greater functional limitation (Boggatz et al, 2010), higher mortality rates and an increased number and duration of hospital readmissions (Landon et al, 2023; Minhas et al, 2023). Living in poverty can also increase the prevalence of multiple chronic conditions (Choi et al, 2020; Minhas et al, 2023; Mira et al, 2023) and antibiotic prescribing rates (Tarkhashvili, 2023). In addition, it is known that living in poverty hinders older adults' ability to implement self‐care behaviours and manage their conditions autonomously (Nwadiugwu, 2021).…”

Health Care Access and Cardiovascular Risk Factor Management Among Working-Age US Adults During the Pandemic

“…Among working-age adults, those with low incomes may have been most susceptible to disruptions in cardiovascular screening and care. [7][8][9] Low-income adults, who already experienced a higher burden of cardiovascular risk factors, 4,[10][11][12] disproportionately shouldered the collateral effects of the pandemic, including unemployment, deepening financial hardship, and challenges affording health care. 13 Therefore, this population may have been slower to regain access to routine cardiovascular care compared with their higher income counterparts as the pandemic went on.…”

“…1,2 At the same time, cardiovascular mortality increased during this period, particularly among socially vulnerable populations. 1,3–6 As the United States emerged from the pandemic, there was growing concern among clinicians and health systems that routine cardiovascular care may not recover back to baseline in working-age adults, which could have devastating implications for cardiovascular health over the long term. Despite this concern, little is known about whether routine access to care, screening for cardiovascular risk factors, and associated risk factor treatment rates returned to prepandemic levels in 2021.…”