Population Well-Being Found to be Indicator of Cardiovascular Disease Mortality


Population well-being was associated with cardiovascular disease morality and rates of conditions such as hypertension, diabetes, and obesity.

Population well-being, including sense of purpose, social relationships, relation to the community, and financial security, is a measurable and modifiable metric focus for immediate intervention to improve cardiovascular disease (CVD) health outcomes, according to the results of a study published in JAMA Network Open.

Credit: eddows - stock.adobe.com

Credit: eddows - stock.adobe.com

The study authors found that the population well-being was associated with CVD morality, independently structural factors, and population health metrics, including rates of hypertension, diabetes, obesity, and physical inactivity across the population.

In the cross-sectional study, investigators used data from the Gallup National Health and Well-Being Index (WBI) survey and the Centers for Disease Control and Prevention Atlas of Heart Disease and Stroke. They used the data to link well-being and county-level rates of CVD mortality.

Individuals were randomly selected and aged 18 years or older from 2015 to 2017. The data were analyzed from August 2022 to May 2023. The primary outcome of the study was the county-level rate of CVD mortality, whereas the secondary outcomes were mortality for stroke, heart failure, coronary heart disease, acute myocardial infarction, and total heart disease.

Investigators analyzed whether the association between population well-being and CVD mortality was affected by county structural factors, such as income inequality and location; and population health factors, such as the percentage of adults who had hypertension, diabetes, obesity, were currently smoking, and physically inactive.

The population WBI and its association of structural factors associated with the structural factors of CVD were assessed with structural equation models.

Investigators included 514,971 individuals in 3228 counties. They found that the mortality rates for CVD decreased from a mean of 499.7 deaths per 100,000 individuals in counties with the lowest quintile of population well-being to 438.6 per 100,000 individuals in counties with the highest quintile of population well-being.

The secondary outcomes also had a similar pattern. Investigators found that the effect size of WBI on CVD mortality had a decrease of 15 deaths per 100,000 individuals for each 1-point increase of population well-being using the unadjusted model. After adjusting for structural factors as well as structural plus population health factors, the effect size was decreased by 7.3 deaths per 100,000 individuals.

In the fully adjusted models, mortality due to coronary heart disease and heart failure were significant, according to the investigators. In the mediated analyses, the association of income inequality, Area Deprivation Index with CVD mortality was partially mediated by the modified population’s WBI.

The study included several limitations. Specifically, the analysis assessed the association of well-being and CVD mortality across the United States in diverse counties, therefore, the rates may be different within other counties.

Additionally, investigators stated that the associated risk for CVD mortality may be hard to associate with different well-being factors, such as obesity, smoking, physical inactivity, and depression, which are known factors of both CVD and well-being.

Investigators removed physical health from the total well-being score to isolate the nontraditional factors associated with CVD.


Spatz ES, Roy B, Riley C, Witters D, Herrin J. Association of population well-being with cardiovascular outcomes. JAMA Netw Open. 2023;6(7):e2321740. doi:10.1001/jamanetworkopen.2023.21740

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