Distribution of Cardiovascular Health by Individual- and Neighborhood-Level Socioeconomic Status: Findings From the Jackson Heart Study

Abstract

Background: Data demonstrate a positive relationship between socioeconomic status (SES) and cardiovascular health (CVH). Objective: To assess the association between individual-and neighborhood-level SES and CVH among participants of the JHS (Jackson Heart Study), a community-based cohort of African Americans in Jackson, Mississippi. Methods: We included all JHS participants with complete SES and CVH information at the baseline study visit (n ¼ 3,667). We characterized individual-and neighborhood-level SES according to income (primary analysis) and education (secondary analysis), respectively. The outcome of interest for these analyses was a CVH score, based on 7 modifiable behaviors and factors, summed to a total of 0 (worst) to 14 (best) points. We utilized generalized estimating equations to account for the clustering of participants within the same residential areas to estimate the linear association between SES and CVH. Results: The median age of the participants was 55 years, and 64% were women. Nearly one-third of eligible participants had individual incomes <$20,000 and close to 40% lived in the lowest neighborhood income category (<$25,480). Adjusted for age, sex, and neighborhood SES, there was an average increase in CVH score of 0.31 points associated with each 1-category increase in individual income. Similarly, each 1-category increase in neighborhood SES was associated with a 0.19-point increase in CVH score. These patterns held for our secondary analyses, which used educational attainment in place of income. These data did not suggest a synergistic effect of individual-and neighborhood-level SES on CVH. Conclusions: Our findings suggest a potential causal pathway for disparities in CVH among vulnerable populations. These data can be useful to the JHS community to empower public health and clinical interventions and policies for the improvement of CVH.

Raising Cardiovascular Health in Low Resource Settings: Challenges and Road Maps Ahead

“…Overall, the results indicate that those with higher levels of individual-and neighborhood-level SES have better CVH score. Specifically, they demonstrated an increase in CVH score with the additive effects of higher individual-and neighborhood-level SES [9]. In an accompanying editorial Global Heart Editor Nathan Wong concludes that the evidence from the Jackson Heart study is a useful advance into helping us understand disparities in SES and CV disease incidence in socioeconomically disadvantaged populations, but prospective investigations to examine whether changes in SES or interventions to improve SES may impact on changes in CV health, and whether this, in turn, translates into reduced CVD outcomes, would be ideal [10].…”

Can Interventions on Socioeconomic Status Improve Cardiovascular Health? Role for American Heart Association’s Life Simple 7

“…In this issue of Global Heart, Foraker et al [1] report on the Jackson Heart Study on the relation of individual and neighborhood socioeconomic status (SES) on cardiovascular (CV) health measured by American Heart Association's Life's Simple 7 (LS7) components of CV health. They found individual (in particular) as well as neighborhood SES to be independently associated with CV health when SES was measured by either income or educational level.…”

“…In the study by Foraker et al [1], the association found between SES and LS7 in the well-characterized Jackson Heart Study cohort of African Americans is proposed as a possible mechanism for the well-known disparities in CV disease incidence that have been observed in African Americans. The authors point out important limitations to the data such as the fact that they do not capture potentially important underlying neighborhood factors such as access to preventive care, racial discrimination, or social support, which could pay a role in the mechanistic pathway proposed.…”

“…Moreover, examining whether the extent to which any relationships of income or education level to future CV event risk in the Jackson Heart Study cohort might be mediated by LS7 scores would have been an even more ideal way to test the authors' hypothesis. In addition, while Foraker et al [1] presented the cumulative LS7 score as the outcome in all analyses, understanding whether certain factors such as diet or exercise habits (or cholesterol or blood pressure) might be the prime drivers of the relationships found would have been helpful. Moving forward, it would be important to examine in a longitudinal design whether increases in an individual or neighborhood's income level or neighborhood's education level actually would relate to improvements in CV health such as that measured by LS7 scores, which would presumably relate to reductions in future CV event risk.…”

“…Further, collaborations among the American Heart Association, World Heart Federation, and CV and public health societies and groups that have direct outreach to not only the public, but also health care providers can help to better disseminate this as well as other electronic health assessment and intervention tools that have the potential to improve community health. The study by Foraker et al [1] is a useful advance into helping us understand how a person's CV health might help explain disparities in SES and CV disease incidence in socioeconomically disadvantaged populations, but clearly, prospective investigations to examine whether changes in SES or interventions to improve SES may impact on changes in CV health, and whether this, in turn, translates into reduced CVD outcomes, would be ideal.…”