It’s worthwhile to develop healthy habits that boost well-being, right? Factors like exercising regularly and eating a nutrient-rich diet can influence your health. However, it’s also true that things you can’t control—like your address, the schools you attended, your financial situation, the work hours you log and the air you breathe—can impact your overall heart health and lifespan, too. New research published in Mayo Clinic Proceedings suggests that people with lower incomes and less access to quality healthcare, education, housing, and job opportunities, are at a greater risk of dying prematurely from cardiovascular disease.
Using files from the U.S. National Center for Health and Statistics, researchers conducted a cross-sectional analysis of death certificate data at the county level from 1999 to 2018, examining people ages 25 to 64 who died from cardiovascular conditions. Researchers used two integrated metrics of socioeconomic deprivation, social deprivation index (SDI) and county area deprivation index (ADI), which measure levels of disadvantages across smaller land areas. Researchers found that counties with higher SDI and ADI had significantly higher total premature cardiovascular mortality, and counties with lower deprivation indicators experienced a more significant decrease in premature cardiovascular deaths.
“This research adds to preexisting literature linking cardiovascular disease with social determinants of health,” says senior study author Sadeer Al-Kindi, MD, cardiologist and co-director of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) at University Hospitals Harrington Heart & Vascular Institute. Social determinants of health include factors like where people live, learn, work and play, and how those affect quality-of-life risks and outcomes. For example, if you don’t have a grocery store with healthy options nearby, you’re less likely to fill up on nutritious foods and that can raise your risk of diabetes, obesity and heart disease.
“Additionally, we found that over the past two decades, the disparities between highly-deprived areas versus low-deprived areas have persisted, without improvement,” says Dr. Al-Kindi. “In fact, the data suggest that the disparities may be widening such that between 1999 and 2018, premature cardiovascular mortality decreased in areas with low social deprivation but increased in areas of high social deprivation.” The study also points to potential reasons why younger people, particularly non-Hispanic Black people and women, die earlier of cardiovascular disease without being completely attributed to traditional risk factors like high cholesterol, hypertension, obesity, smoking, diabetes, or physical inactivity.
So what does all this mean? Sure, living healthy involves taking care of ourselves with the choices we make, like eating wholesome food, exercising, not smoking, and getting good sleep. However, conversations about wellness are incomplete without acknowledgment that our well-being is also determined by access to economic and social opportunities, education quality, workplace safety and basics like clean air, food and water. “The conditions in which we live explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be,” according to the Office of Disease Prevention and Health Promotion.
The study also hints at the need to create social and physical environments that promote good health for all. Programs that enhance quality of life can positively influence population health outcomes. And resources from affordable housing, quality education and public safety to nutritious eats, nearby health services, and toxin-free living and work environments can make longevity more possible.
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