Heart disease deaths declining, but not for everyone

Published in the Journal of the American Heart Association, the study showed that deaths from heart disease consistently declined at the county level from 2009 to 2018.

"Even though the rates of cardiovascular disease are decreasing, the gaps between rural and urban health and counties with more Black residents are not decreasing," said Heejung Son, lead author of the study and a doctoral student in the College of Public Health. "The main point of our study is that we need to try to find ways to reduce those gaps."

Food insecurity, low income, housing instability risk factors for heart disease

The researchers relied on data from the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality that covered more than 3,100 counties across the country.

The agency's annual survey is designed to understand the relationship between community-level factors such as demographics or socioeconomic status of communities, access to quality health care and emerging health issues like cardiovascular disease or obesity.

The researchers found that factors such as food insecurity and housing instability also played a large role in counties with higher rates of cardiovascular disease and death. Deaths from heart disease were significantly lower in counties with higher household income levels and in areas where more individuals had Medicare coverage.

Previous research has shown that chronic stress caused by low wages can create inflammation in the body that leads to illness, which may explain the connection between low socioeconomic status and higher rates of death by cardiovascular disease, the researchers said.

"The environment that we are born, live and grow in has an effect on our health," said Zhuo "Adam" Chen, co-author of the study and an associate professor of health policy and management. Chen also serves as co-chair of the College of Public Health's health disparities research working group. "Social factors, such as those that affect our income, housing conditions and transportation -- people may not make the connection that those things affect our health as well."

The study also showed that cardiovascular disease caused more deaths in counties where more residents lived in mobile homes, relied on food stamps (or the Supplemental Nutrition Assistance Program) or had only a high school education.

Increasing access to health care would be a great start to closing the cardiovascular health disparities, and making food stamps more available could help too. Addressing the unavailability of affordable housing and health care provider shortages will likely require government action, though, Chen said.

"We need to be thinking outside of the box," Chen said. "This study presents evidence for stronger interventions related to housing, income support and food security. We need to be proactive instead of waiting for people to get sick to provide medical care."

The study was co-authored by the College of Public Health's Ye Shen and Janani Rajbhandari-Thapa, and the Department of Geography's Jielu Zhang and Lan Mu. Other co-authors include researchers from New York University, Icahn School of Medicine at Mount Sinai and Shanghai Jiao Tong University School of Medicine.