Cardiovascular Disease Prevalence Changes Depending on Income Level


Cardiovascular disease incidence decreased for the top 20% of earners, but showed varying growth for the bottom 80% of earners depending on the condition.

The prevalence of cardiovascular disease (CVD) decreased primarily in the top 20% of earners and declined at a much slower rate, stayed the same, or increased for the bottom 80% of earners depending on the cardiovascular condition, according to a recent study published in JAMA Network Open.

Income disparity between the top 20% of earners and the remainder of the US population has grown dramatically over the past few decades, according to the study. The association between income and health has been well established and may help to provide insights into the CVD burden among US adults.

The study was a cross-sectional analysis of 44,986 participants chosen from 9 cycles of the National Health and Nutritional Examination Survey between 1999 and 2016. Participants were adults aged 20 years and older and statistical analysis of the data was conducted in December 2019.

The high-resources group included 7926 participants, 50.3% of whom were in the 40- to 59-year age group. A little more than half, 51.9%, of the high-resource group was male. The remainder of the population included 37,060 participants, with 34.1% in the 40- to 59-year age group, of whom 53.2% were women.

Over the course of the study the prevalence of angina in the highest-resource group decreased from 3.4% to 0.3%. The rate of heart attack fell from 3.2% to 1.4% and the rate of congestive heart failure (CHF) fell from 1.2% to 0.5%, according to the study.

For the remainder of the population, the rate of angina decreased from 3.3% to 2.6% over the course of the study. There was also a small decrease in the rate of heart attack from 4.0% in 1999 to 3.6% in 2016. However, the rate of CHF increased from 2.6% to 2.8%, according to the study.

“We believe that this study recasts the understanding of the differences in CVD prevalence as one driven by the differences between persons in the richest quantile whose income and assets continue to increase and persons in the rest of the population whose socioeconomic achievements are stagnant,” the study authors said in a press release. “This viewpoint contrasts with the dominant approach of comparing those in the top 1% of the economy with everyone else. A substantially different architecture of inequality, one that points to other solutions, is needed. Policy and public health efforts should be directed to mitigate the consequences of these inequality dynamics.”

The study had several limitations, for example, outcomes related on self-reported information. Additionally, the structure of the data limited investigators’ ability to create a clear 20 to 80 income cutoff, according to the press release.


Abdalla, Salma MBBS, MPH, Galea, Sandro, DrPH, MPH, MD Trends in Cardiovascular Disease Prevalence by Income Level in the United States JAMA Network Open; September 25, 2020.

doi:10.1001/jamanetworkopen.2020.18150. Accessed September 28, 2020.

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