国家心脏健康的成功故事并不适合每个人

整个美国的心血管健康状况都有了显著改善.S. 在过去的几十年中, but those gains were enjoyed almost exclusively by the wealthiest segments of the population, 一项新的分析发现.

防治心血管疾病的进展掩盖了广泛的事实, income-driven inequities in cardiovascular health that emerged and have grown increasingly wider since the late 1980s, 根据 新发现, published Wednesday in the 美国心脏协会 journal Circulation: Cardiovascular Quality and Outcomes.

"The large reduction in cardiovascular risk – one of the main accomplishments of clinical and public health in the U.S. over the past half-century – was a benefit that was not equally shared," said lead study author Dr. 亚当·理查兹, an associate professor of global health and medicine at George Washington University Milken School of Public Health in Washington, D.C. “收入较低的人受益不大, 然而，所有的好处都集中在高收入人群身上."

根据 疾病控制和预防中心的数据, improvements in treatment and reductions in cardiovascular risk factors led to a 56% decline in heart disease death rates during the second half of the 20th century. 中风死亡率下降了70%.

But a growing body of research reveals gains made during that time and since have not been equitably distributed. 理查兹说 he and his colleagues wanted to explore how widespread those inequities might be by analyzing health and income data more thoroughly across a wider age group and over a longer period of time than previous studies.

他们分析了26,633名美国人的数据.S. adults assessed by the CDC's National Health and Nutrition Examination Survey from 1988 to 1994 and from 1999 to 2018. Participants were 40 to 75 years old and had no history of cardiovascular disease at the time of enrollment. They participated in household surveys as well as a physical examination to collect data, 包括收入状况和心血管疾病的危险因素. 收入从等于或低于贫困线到高于贫困线五倍不等. (Updated annually, the federal poverty level for 2024 is $31,200 for a family of four.)

整体, the population's predicted risk of having a heart attack or stroke within 10 years dropped dramatically over the 30-year study period. 但这些收益只适用于收入最高的两个群体.

10年心血管风险从7年下降.7% to 5.最富有人群的税率从1%提高到7%.6% to 6.第二富有的群体占1%. 但对于收入最低的人来说，风险从8%增加到8%.1% to 8.7%，但增幅没有达到统计学意义.

The gains for people at the top of the income ladder widened the gap in cardiovascular disease risk between the two groups, 这在20世纪80年代末的研究开始时几乎是不存在的, 理查兹说. 在研究结束时, people at or below the poverty line faced a 70% higher risk of having a heart attack or stroke than their peers with an income five times higher, 差距扩大了8倍多.

The findings suggest cardiovascular mortality among people with lower incomes also could be "contributing to the well-documented flattening of trends toward increased life expectancy, driven largely by slowed or reversal of progress among lower socioeconomic groups,理查兹说.

“围绕这个话题的讨论一直集中在绝望的死亡上, 比如事故和用药过量,他说. “但如果你关注穷人被抛在后面的事实, our study suggests cardiovascular disease should also probably be part of that conversation."

The findings point to another gap – the lack of routine analysis of how new policies, 治疗和干预可能影响不同的亚组, 博士说. Debra Dixon, a cardiologist at Vanderbilt University Medical Center in Nashville, Tennessee. 她没有参与这项新研究.

例如, 研究表明，获得重要心血管干预措施的机会不平等, 比如治疗有缺陷的心脏瓣膜, 针对黑人和西班牙裔患者以及低收入人群.

“治疗方面的创新是有益的, 但如果没有一种为所有人创造机会的方式, 它们加剧了不平等,迪克森说.

Inequities are often the result of structural racism and other social drivers of health, 根据… 编辑 与迪克森合著，并与该研究同时发表. 例如, the historical and racially discriminatory lending practice known as "redlining" set the stage for poor housing conditions that, combined with a lack of access to health care services in underserved neighborhoods, 帮助维持和加剧了健康不平等. These underlying conditions must be addressed if those gaps are to narrow, she said.

但迪克森说，这需要价值观的转变. "We need policies that support the opportunity for everyone to live a healthy life."