Association of Socioeconomic Status With Ideal Cardiovascular Health in Black Men

Abstract

Background Black men are burdened by high cardiovascular risk and the highest all‐cause mortality rate in the United States. Socioeconomic status (SES) is associated with improved cardiovascular risk factors in majority populations, but there is a paucity of data in Black men. Methods and Results We examined the association of SES measures including educational attainment, annual income, employment status, and health insurance status with an ideal cardiovascular health (ICH) score, which included blood pressure, glucose, cholesterol, body mass index, physical activity, and smoking in African American Male Wellness Walks. Six metrics of ICH were categorized into a 3‐tiered ICH score 0 to 2, 3 to 4, and 5 to 6. Multinomial logistic regression modeling was performed to examine the association of SES measures with ICH scores adjusted for age. Among 1444 men, 7% attained 5 to 6 ICH metrics. Annual income <$20 000 was associated with a 56% lower odds of attaining 3 to 4 versus 0 to 2 ICH components compared with ≥$75 000 ( P =0.016). Medicare and no insurance were associated with a 39% and 35% lower odds of 3 to 4 versus 0 to 2 ICH components, respectively, compared with private insurance (all P <0.05). Education and employment status were not associated with higher attainment of ICH in Black men. Conclusions Among community‐dwelling Black men, higher attainment of measures of SES showed mixed associations with greater attainment of ICH. The lack of association of higher levels of educational attainment and employment status with ICH suggests that in order to address the long–standing health inequities that affect Black men, strategies to increase attainment of cardiovascular health may need to address additional components beyond SES.

Historical Redlining, Socioeconomic Distress, and Risk of Heart Failure Among Medicare Beneficiaries

“…34,37 Moreover, persistent gaps in cardiovascular mortality between Black and White adults have been demonstrated in wealthy communities and among highly educated Black men, suggesting that, although cardiovascular outcomes may be influenced by socioeconomic disparities, the effect of structural racism on health disparities likely extends beyond the neighborhood and individual wealth. 38,39 It is notable that the risk conferred by redlining was unique to HF and was not observed for the outcome of hip fractures, supporting the conclusion that the neighborhood environment is of particular importance to cardiovascular health, which may be more influenced by long-term exposure to psychosocial stress, socioeconomic disadvantage, and reduced access to health care.…”

Contextualizing the Chronic Care Model among Non-Hispanic Black and Hispanic Men with Chronic Conditions

“…While participants’ sociodemographics differed by race/ethnicity more so than by age, the younger age groups, irrespective of race/ethnicity, reported a lower prevalence of living in a metro area, a lower prevalence of having health insurance coverage, had lower income, and lived with more people on average. Such physical and social contextual information about this younger age group provides initial insight into the additional structural influences that may influence their ability to take care of their own health [ 31 , 32 ].…”

Addressing non-medical health-related social needs through a community-based lifestyle intervention during the COVID-19 pandemic: The Black Impact program

“…Thus, the findings of Black Impact showing no association of social needs and Life's Simple 7 at baseline are an important contribution to the limited extant literature. The lack of association of social needs with LS7 in Black Impact may be due to multiple factors as previously noted by Azap et al including "John Henryism", allostatic load from multiple stresses including racism and discrimination, discrimination and bias in the healthcare setting leading to medical mistrust, and inequities in wealth, such that those without social needs, may still have difficulty attaining high levels of cardiovascular health [14,29]. Further studies addressing the role of social needs in LS7 cardiovascular health are a critical area of inquiry to discern the role and mechanisms of social needs in cardiovascular risk factors particularly among racial/ethnic minority sex groups.…”

“…Thus, it is unclear if these findings are consistent in Black men. In Black men participating in US AAMWA Walks there was no association of higher levels of education or employment status with six components (excluding diet) of the LS7 cardiovascular health scores, but were positive associations with income and insurance [14]. Caleyahetta et al showed that a higher cumulative risk score summing four socioeconomic status measures (low family income, low education level, minority race, and single-living status) was associated with lower attainment of LS7 [52].…”

“…In Black adults in the Jackson Heart Study, lower individual income, neighborhood socioeconomic status, and education were all significantly associated with lower American Heart Association (AHA) Life's Simple 7 (LS7) scores (LS7 metrics include physical activity, diet, cholesterol, blood pressure, body mass index (BMI), smoking, and glycemia) [13]. In community-dwelling Black men participating in African American Male Wellness Walks, lower annual income (<$20,000 vs. �$75,000) and Medicare or no insurance vs. private insurance were associated with worse AHA cardiovascular health [14]. Unfortunately, interventions addressing social needs and cardiovascular risk factors have been limited in all populations, including racial/ethnic minority groups.…”