Nation's heart health success story not written for everyone

Cardiovascular health has improved dramatically across the U.S. over the past several decades, 但这些收益几乎完全被人口中最富有的部分所享受, a new analysis finds.

The progress made against cardiovascular disease masked broad, 收入驱动的心血管健康不平等现象自1980年代末以来出现并日益扩大, 根据 新发现, 周三发表在美国心脏协会期刊《沙巴足球体育平台》上.

“心血管风险的大幅降低是美国临床和公共卫生的主要成就之一.S. 在过去的半个世纪里，这种好处并没有被平等地分享。. 亚当·理查兹, 他是华盛顿乔治华盛顿大学米尔肯公共卫生学院全球健康和医学副教授, D.C. "People who earn less income did not benefit much, whereas all the benefit was concentrated among people with higher incomes."

根据 Centers for Disease Control and Prevention data, 在20世纪下半叶，治疗的改善和心血管危险因素的减少导致心脏病死亡率下降了56%. The stroke death rate fell 70%.

但越来越多的研究表明，在此期间以及此后取得的成果并没有得到公平分配. 理查兹说，他和他的同事们想通过比以前的研究更彻底地分析更广泛的年龄组和更长的沙巴足球体育平台内的健康和收入数据，来探索这些不平等可能有多普遍.

Their analysis looked at data for 26,633 U.S. 美国疾病控制与预防中心1988年至1994年和1999年至2018年进行的全国健康与营养调查评估的成年人. 参与者年龄在40到75岁之间，在入组时没有心血管疾病史. 他们参加了家庭调查和身体检查，以收集数据, including income status and cardiovascular disease risk factors. Incomes ranged from at or below the poverty level to five times above that. (2024年的联邦贫困线每年更新一次，一个四口之家的贫困线为31,200美元.)

整体, 在30年的研究期间，人们在10年内患心脏病或中风的预测风险大幅下降. But those gains only applied to people in the top two income groups.

The 10-year cardiovascular risk fell from 7.7% to 5.1% for the wealthiest segment of the population and from 7.6% to 6.1% for the second-wealthiest group. But for people with the lowest incomes, risk increased from 8.1% to 8.7%, though the increase did not reach statistical significance.

高收入人群的收入增加扩大了两组人群患心血管疾病风险的差距, which was almost nonexistent at the beginning of the study in the late 1980s, 理查兹说. By the end of the study, 处于或低于贫困线的人患心脏病或中风的风险比收入高出五倍的同龄人高出70%, broadening the gap more than eightfold.

研究结果表明，低收入人群的心血管疾病死亡率也可能是“有充分证据证明的预期寿命增长趋势趋于平缓的原因”, 主要是由于社会经济地位较低群体的进步放缓或逆转,理查兹说.

"The conversation around this has focused on deaths of despair, such as accidents and overdoses,他说. "But if you focus on the fact that poor people are being left behind, 我们的研究表明，心血管疾病也可能是谈话的一部分."

研究结果指出了另一个缺口——缺乏对新政策效果的常规分析, treatments and interventions may be affecting different subgroups, 博士说. 黛布拉·迪克森是田纳西州纳什维尔范德比尔特大学医学中心的心脏病专家. She was not involved in the new research.

例如, studies have shown unequal access to important cardiovascular interventions, such as procedures that treat faulty heart valves, for Black and Hispanic patients and people with lower incomes.

"Innovations in treatment are helpful, but if not accompanied by a way to create access for all, they worsen inequities,迪克森说.

不平等往往是结构性种族主义和其他健康问题社会驱动因素的结果, 根据… 编辑 co-authored by Dixon and published concurrently with the study. 例如, 被称为“红线”的历史和种族歧视的贷款做法为恶劣的住房条件奠定了基础, 再加上服务不足的社区缺乏获得保健服务的机会, helped perpetuate and exacerbate health disparities. 她说，如果要缩小这些差距，就必须解决这些潜在的问题.

But that will require a shift in values, Dixon said. “我们需要政策支持每个人都有机会过上健康的生活."