For Patients With Chronic Inflammation, Poverty Increases Cardiovascular Risk

For patients with chronic inflammation, the effects of poverty could reduce health and life expectancy even further, demonstrating that this population has significantly worse health outcomes independent from their health effects, according to results of a study published in Frontiers in Medicine.^1,2

“We found that participants with either inflammation or poverty alone each had about a 50% increased risk in all-cause mortality. In contrast, individuals with both inflammation and poverty had a 127% increased heart disease mortality risk and a 196% increased cancer mortality risk,” Frank A. Orlando, MD, FAAFP, an associate professor at the University of Florida, said in the press release. “Since the observed 127% and 196% increases are much greater than 100%, we conclude that the combined effect of inflammation and poverty on mortality is synergistic.”¹

According to a press release, it has been shown that poverty negatively impacts physical and mental health, showing those in poverty have greater risks of mental illness, heart disease, hypertension, stroke, and higher mortality and lower life expectancy. Investigators of the current study were the first to show the effects on poverty with chronic inflammation. Chronic inflammation can be caused by exposure to environmental toxins, certain diets, autoimmune disorders, and other chronic diseases, according to the press release.¹

In the study, investigators analyzed data from adults aged 40 and older who were enrolled between 1999 and 2002 in the National Health and Nutrition Examination Survey. Individuals were followed until December 2019, according to the press release. The data was combined with records from the National Death Index to calculate the mortality rates and household income was divided by the official poverty threshold to calculate the poverty index ratio.¹

Additionally, investigators used plasma concentration of high sensitive C-reactive protein (hs-CRP), which was available in the database. The elevation of hs-CRP concentrations have been shown to increase the risk of cardiovascular disease and all-cause mortality, according to the press release. Investigators considered a concentration of 0.3 mg/dl hs-CRP as chronic systemic inflammation, but also evaluated for 1.0 mg/dl in a separate analysis. Investigators separated individuals into 4 groups, including with or without chronic inflammation and living below the poverty line or above.¹

“It’s important for guidelines' panels to take up this issue to help clinicians integrate inflammation screening into their standard of care, particularly for patients who may have factors that place them at risk for chronic inflammation, including living in poverty. It is time to move beyond documenting the health problems that inflammation can cause, to trying to fix these problems,” Arch Mainous, PhD, a professor at the University of Florida, said in the statement.¹

Treatments for systemic inflammation can range from diet and exercise to nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids. The investigators suggested the physicians should consider screening individuals who are socially disadvantage, as they are already a medically vulnerable population, for chronic inflammation. They added that more research should be conducted before patients are routinely prescribed NSAIDs or steroids as they can come with risks when taken in the long term, according to the press release.¹

Reference

1. Living in poverty with chronic inflammation significantly increases heart disease and cancer mortality risk, study finds. News release. EurekAlert. January 16, 2024. Accessed January 16, 2023. https://www.eurekalert.org/news-releases/1030847?
2. Mainous A, Orlando FA, Yin L , Sharma P, Wu V, Saguil A. Inflammation and Poverty as Individual and Combined Predictors of 15-year Mortality Risk in Middle Aged and Older Adults in the US. Front Med. 2024. doi: 10.3389/fmed.2023.1261083