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A new study published in The Lancet Regional Health—Americas has highlighted an alarming rise in cardiovascular health disparities in the United States, showing that income and education levels significantly influence heart disease risk.
The research, led by Salma Abdalla, MBBS, DrPH, an assistant professor of public health at Washington University in St. Louis, found that the top 20% of high-income, college-educated Americans have much lower rates of cardiovascular disease compared to the rest of the population. The study also revealed that these disparities have grown over the past two decades, exacerbating an already concerning public health issue.
Wealth and Education Impact Heart Health
Cardiovascular disease (CVD) remains the leading cause of illness and death in the U.S., yet the study suggests a diverging trend where wealthier, more educated individuals experience better heart health. In contrast, the remaining 80% of the population faces significantly higher risks, reflecting the nation’s widening income gap.
Despite the U.S. spending more per person on healthcare than any other high-income country, health outcomes continue to lag—especially for those with lower incomes and less education. According to the study, life expectancy for the richest 1% of Americans is now 10 years longer than for the poorest 1%, a disparity that has worsened over time.
Analyzing Two Decades of Data
The study analyzed 20 years of data from nearly 50,000 adults who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. Participants were categorized based on income and education levels, with researchers examining the prevalence of four major cardiovascular conditions: congestive heart failure, angina, heart attack, and stroke.
Findings from statistical models showed that low-income, non-college graduates had:
- 6.34 times the odds of congestive heart failure,
- 2.11 times the odds of angina,
- 2.32 times the odds of a heart attack, and
- 3.17 times the odds of a stroke
compared to their wealthier, college-educated counterparts. These disparities persisted even after adjusting for demographic factors and key health indicators such as body mass index (BMI), blood pressure, and cholesterol levels.
Structural Barriers and Health Outcomes
The study suggests that wealth and education influence heart health through multiple intersecting pathways. A lack of economic security can contribute to chronic physiological stress, while higher-income individuals are more likely to access health-promoting resources, receive preventive care, and adhere to prescribed treatments. They also tend to experience lower environmental toxin exposure and benefit from stronger social support networks.
“The accumulation of economic and educational advantages appears to drive better health outcomes, rather than any single factor alone,” said Abdalla. “Wealth and education cluster among a small, advantaged group, while the majority of Americans face an increased risk of heart disease.”
Policy Implications
The study’s senior author, Sandro Galea, MD, DrPH, the Margaret C. Ryan Dean of the School of Public Health at Washington University, emphasized that addressing cardiovascular disease requires more than just expanding healthcare access.
“The continued widening of health disparities in the U.S. underscores the need for action,” Galea said. “If we want to improve public health outcomes, we must address the root causes—economic opportunity, education, and access to resources that support long-term health.”
Conclusion
As economic inequality grows, so does the health divide. Experts suggest that policies promoting educational equity, economic stability, and preventive healthcare interventions could help mitigate these disparities, improving cardiovascular health for all Americans.
Disclaimer: This article summarizes findings from a peer-reviewed study published in The Lancet Regional Health—Americas. It is intended for informational purposes only and should not be used as a substitute for professional medical advice or treatment. Readers concerned about their cardiovascular health should consult a qualified healthcare provider.
