Economic stress leads to fatal heart attacks

Communities in the United States that experienced the most economic distress in the wake of the Great Recession saw a significant increase in death rates from heart disease and strokes among middle-aged people, according to a new multi-institution study.

While the death rates remained nearly unchanged in counties with the least economic distress (62.6 deaths per 100,000 residents in 2010; 61.5 in 2015), areas experiencing worsening economic trends—such as high unemployment, lower median incomes and lack of affordable housing—saw a sharp increase, from 122 deaths per 100,000 residents in 2010 to 127.6 deaths in 2015.

Authors say the findings, which were presented at the American Heart Association's 2019 Scientific Sessions in Philadelphia, underscore how economic disparities contribute directly to health disparities.

What the researchers say:

"Our study shows that large economic trends—whether it's a significant reduction in employment or a recession—have a real impact on communities and on the cardiovascular health of people living in those communities," said the study's lead author. "It's important that policymakers, physicians and even patients are aware of this increase in mortality rates. Interventions, such as policies like a health insurance expansion, may help slow this trend or even reverse it."

After more than 50 years of steep declines, cardiovascular death rates in the United States have been nearly stagnant since 2011—with rates even rising in some groups of middle-aged adults, according to data from the Centers for Disease Control and Prevention (CDC). Although it's known that the United States has experienced an uneven recovery following the Great Recession, it hasn't been clear whether economic factors contribute to the varying—and, in some cases, heightened—heart disease death rates in communities nationwide.

The team examined county-level cardiovascular mortality rates, spanning 2010 to 2015, for adults aged 25 to 64. They also pulled county-level values for the Distressed Communities Index, which combines seven markers of economic activity, such as income, access to housing, and educational attainment. In order to identify links between cardiovascular mortality and economic distress, the team also included a variety of other factors, such as county-level health insurance coverage, the prevalence of obesity and diabetes and density of primary care providers.

They found counties with the highest Distressed Communities Index rating at baseline also had the highest baseline cardiovascular mortality and saw the largest increases in deaths from 2010 to 2015. Additionally, the counties that had worsening economic distress experienced a significantly greater increase in heart disease deaths compared to counties with the lowest ratings, independent of baseline economic distress.

"We found that it's not a uniform increase—communities experiencing the most economic difficulties are the ones that are hardest-hit by heart disease deaths," the researchers said.

So, what?

This research is hardly surprising. Economic hardship—either in relative or absolute terms—is known to have a profound effect on the immune system. We get the same effect if we’re dismissed from our job, demoted to a lesser-status position or retire with less income or even simply move from a wealthy to an impoverished area to live or work.