Skip to comments.Disparities in cardiovascular risk based more on socioeconomic status than race, ethnicity
Posted on 08/02/2010 1:36:10 PM PDT by Pharmboy
A new UCLA study suggests that disparities in cardiovascular disease risk in the United States are due less to race or ethnicity than to socioeconomic status.
In the study, published in the August issue of the journal Annals of Epidemiology, researchers from the David Geffen School of Medicine at UCLA and colleagues found that there are large differences in risk by socioeconomic status within racial and ethnic groups with the poorest individuals having the highest risk but that there are few differences in risk between racial and ethnic groups.
"Most ethnic differences in cardiovascular risk are really due to socioeconomic differences between the races in the U.S. except for one outstanding exception," said lead researcher Dr. Arun Karlamangla, an associate professor of medicine in the division of geriatrics at the Geffen School of Medicine. "Foreign-born Mexican Americans, as opposed to Mexican Americans born here, are healthier than everyone else, and this may have less to do with ethnicity or genes than with migration patterns."
Previous studies have found large differences in health outcomes by both socioeconomic status and race and ethnicity, and these are thought to be due to differences in access to care, health behaviors, and levels of economic and social stresses, which have been linked to heart disease.
Racial disparities in health have also raised the question of whether there is a genetic component to these differences, but it has been difficult to untangle real racial and ethnic disparities from socioeconomic disparities because of the higher numbers of socioeconomically disadvantaged individuals in minority racial and ethnic groups.
Using data from 12,154 individuals in the National Health and Nutrition Examination Survey (2001), the study authors examined the 10-year risk for coronary heart disease as predicted by the National Cholesterol Education Program Adult Treatment Panel III guidelines, updated in 2004 as well as the prevalence of metabolic syndrome and overt diabetes mellitus, a major contributor to coronary heart disease risk, among various racial and ethnic groups.
To separate out socioeconomic risk differences from racial and ethnic differences, the researchers examined socioeconomic disparities separately within the racial and ethnic groups, which included non-Hispanic whites, non-Hispanic blacks, U.S.-born Mexican Americans and foreign-born Mexican Americans (those born in Mexico but living in the U.S.). They also examined racial and ethnic differences among individuals from the same socioeconomic stratum.
The researchers found that the lower the socioeconomic status, the higher the risk in all racial and ethnic groups. A large fraction of the difference in cardiovascular and diabetes risk could be linked to differences in lifestyle. For instance, there is more smoking, less physical activity and more obesity among the poor.
By contrast, the researchers found inconsistent racial and ethnic risk disparities in some though not all socioeconomic strata. Non-Hispanic blacks and Mexican Americans born in the U.S., for example had higher risk, but Mexican Americans born in Mexico had lower risk.
This surprising finding could be explained by selection pressures in migration, according to Karlamangla.
"Only the healthy are able to migrate here, and the unhealthy go back for their care," he said.
The researchers did note some limitations in the study, such as false discovery stemming from the multiple testing for disparities within four racial and ethnic groups and three socioeconomic strata, and the possibility that effects of health behaviors on risks can vary by ethnicity, which makes it more difficult to control for these factors.
Still, "this large national study documents strong, inverse socioeconomic gradients with coronary heart disease risk in all race/ethnicity groups, and demonstrates that race/ethnicity disparities in risk are primarily due to socioeconomic differences between the groups," the researchers conclude. "Socioeconomically disadvantaged individuals need to be specifically targeted for early risk detection and management and health behavior counseling if we are to improve the cardiovascular health of the nation."
### Additional study researchers were Sharon Stein Merkin and Teresa E. Seeman of UCLA and Eileen M. Crimmins of the University of Southern California.
The National Institutes of Health funded this study.
The UCLA Division of Geriatrics within the department of medicine at the David Geffen School of Medicine at UCLA offers comprehensive outpatient and inpatient services at several convenient locations and works closely with other UCLA programs that strive to improve and maintain the quality of life of seniors. UCLA geriatricians are specialists in managing the overall health of people age 65 and older and treating medical disorders that frequently affect the elderly, including falls and immobility, urinary incontinence, memory loss and dementia, arthritis, high blood pressure, heart disease, osteoporosis, and diabetes. As a result of their specialized training, UCLA geriatricians can knowledgably consider and address a broad spectrum of health-related factors including medical, psychological and social when treating patients.
For more news, visit the UCLA Newsroom or follow us on Twitter.
...and they may lose their grant money for this finding.
Hmmmm...! Are we concerned, or UNconcerned about their health, I wonder...?
Do we have COMPASSION for them? Do we REALLY?
Because poor people eat more pork.
It could also be explained by early diet and activity. I suspect poor Mexican kids are not as fat as poor American kids and probably are more active. (sorry to post this twice, but I realized I had forgotten to break my comment from the quote!)
If you haven't seen it: Socioeconomic status predicts survival of Canadian cancer patients
Socioeconomic status would seem to be a determinant of many outcomes.
There would appear to be some really bad science represented here. Last year a 20 year longitudinal study revealed that African Americans had a 2000% increased risk for early cardiac mortality when compared to white Americans between the ages of 40 and 50. There is evidence to support that one half of that risk is associated with low vitamin D stores.
Now if only someone would do a study on what causes you to be in a certain socioeconomic status...
At 58, I’m alive today (avoiding death by prostate cancer) in part because of intelligence and motivation. Yes, unequal outcomes apply here also.
LOL! This one sentence prompts me to think the entire article is bunk.
There is a direct correlation between income and intelligence. There is an inverse correlation between income and cardiovascular risk.
I'm taking bets that intelligence influences cardiovascular risk. Like maybe, smart people understand health risks and act to avoid those risks... Being dumb is a harsh burden in life.
Yes, and I think the vitamin D story is getting out. My neurologist insisted that I have mine checked and that I take megadoses now. I think more doctors are now aware of that as an issue.
Lol, and how many times have I been asked: if you are so smart, how come you are not rich?
Intelligent people are more motivated for good health, usually. For me life is good, I have not peaked mentally; in my opinion :)
There is a continuous flow new adventures, relationships, challenges and opportunities. There must be a minimum income level to persue it all, but you don't have to be wealthy.
"I'm half white, and less than half black, the rest being Arab, so eat your *own* heart out, cracker!"
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