Model: Lower Socioeconomic Status Linked with Higher Heart Disease Burden

Having lower socioeconomic status was associated with a disproportionate share of coronary heart disease (CHD) burden, a new analysis suggests.

“Individuals with low socioeconomic status bear a disproportionate share of the CHD burden, and CHD remains the leading cause of mortality in low-income US counties,” the authors wrote. “[We estimated] To estimate the excess CHD burden among individuals in the United States with low socioeconomic status and the proportions attributable to traditional risk factors and to other factors associated with low socioeconomic status.”


To project the excess burden of early CHD, the study authors conducted the study with a computer simulation using the Cardiovascular Disease Policy Model, which is a standard model of CHD and stroke prevalence, incidence, and mortality among U.S. adults. They estimated the proportion of the excess burden that was attributable to normal risk factors such as smoking, high blood pressure, high LDL-C levels, and others, and compared that with the proportion of attributable  to other risk factors associated with lower socioeconomic status. All U.S. adults aged 35 to 64 years, stratified by socioeconomic status, were included in the computer simulations, and inputs were derived from nationally representative US data and cohort studies of incident CHD. The primary study outcome was premature myocardial infarction rates and CHD deaths.

According to the study results, about 31.2 million U.S. adults had lower status (51.3% women). When compared to individuals with higher status, both men and women in the lower status group had twice the rate of myocardial infractions and CHD deaths per 100,00 person-years. Higher CHD burden of traditional risk factors for CHD in those with lower status explained about 40% of the excess events, while the remaining 60% were explained by other factors related to lower socioeconomic status. The model projected that in a simulated cohort of 1.3 million adults with lower socioeconomic status, 250,000 (19%) would develop CHD by age 65, with 119,000 (48%) of those occurring in excess of those expected for individuals with higher status.

“These findings suggest that, although addressing traditional risk factors may decrease CHD, the disparities in disease burden will likely remain unless upstream factors associated with low socioeconomic status are addressed,” the authors wrote.

This study was published in JAMA Cardiology.