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 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.
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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.
SOURCE: http://bit.ly/1f4U4k9 Journal of the American Heart
Association, released May 27, 2015.
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