image: Researchers report that behavioral risk factors such as smoking and physical inactivity may explain a majority of the inequalities in ischemic heart disease risk between people of differing socioeconomic status (as defined by educational level). For men, smoking and physical inactivity behaviors combined explained more than half (56%) of the observed inequalities in heart disease mortality. Other key factors were alcohol intake and BMI.
Credit: Anne-Lise Paris, (www.in-graphidi.com), PLOS, CC-BY 4.0 (https://creativecommons.org/licenses/by/4.0/)
Lower socioeconomic status is associated with higher rates of death from coronary artery disease compared to higher socioeconomic status, and more than half of the disparities can be explained by four unhealthy behaviors. Dr. Yachen Zhu of the Alcohol Research Group, U.S., and Dr. Charlotte Probst of the Centre for Addiction and Mental Health, Canada, report these findings in a new study published September 17th in the open-access journal PLOS Medicine.
Coronary artery disease, also known as coronary heart disease or ischemic heart disease, occurs when the arteries supplying the heart cannot deliver enough oxygen-rich blood due to plaque buildup, and is a major cause of death in the U.S. The condition poses a greater risk to people with lower socioeconomic status, but previous studies have reported conflicting results on whether certain unhealthy behaviors, like smoking, are primarily responsible for the observed disparities in deaths from the disease.
In the new study, researchers used data from 524,035 people aged 25 years and older whose mortality statuses were recorded in the National Death Index and who answered the National Health Interview Survey on demographics and health behaviors. The team used education as the primary indicator for socioeconomic status, and investigated four behavioral risk factors: smoking, alcohol use, physical inactivity and BMI. The four factors together explained 74% of the differences in mortality risk from coronary artery disease in men belonging to different socioeconomic levels and 61% in women.
The researchers conclude that their results highlight the need for effective public health policies and interventions that address each of these behaviors – both separately and together – because unhealthy behaviors often cluster among individuals from low socioeconomic backgrounds. They urge public health campaigns to raise awareness about heart health with messaging and outreach efforts customized for male and female audiences. The authors add, “These efforts are crucial to reducing the socioeconomic disparities in deaths from coronary artery disease in the U.S.”
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In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004455
Citation: Zhu Y, Llamosas-Falcón L, Kerr WC, Rehm J, Probst C (2024) Behavioral risk factors and socioeconomic inequalities in ischemic heart disease mortality in the United States: A causal mediation analysis using record linkage data. PLoS Med 21(9): e1004455. https://doi.org/10.1371/journal.pmed.1004455
Author Countries: United States, Canada, Germany, Spain
Funding: This research was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number R01AA028009 (to CP). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Journal
PLOS Medicine
Method of Research
Observational study
Subject of Research
People
COI Statement
Competing Interests: see manuscript