In 2009, one in nine U.S. deaths included heart failure as contributing cause, according to the Centers for Disease Control (CDC). And about half of the people who develop heart failure die within five years of their diagnosis. What role do poverty and the barriers to a healthy lifestyle that often accompany it play?
A study recently published in the Open Access Journal of the American Heart Association found that heart failure rates were highest in the poorest counties in the U.S. Heart failure, a progressive, chronic position, is characterized by the heart muscle being unable to pump an adequate amount of blood to meet a body’s needs. Coronary heart disease; heart attacks; high blood pressure; diabetes; smoking tobacco; consuming foods high in fat, sodium and cholesterol; a lack of physical activity; and obesity can all raise a person’s risk of developing heart failure. According to EurekAlert, approximately two-thirds of the correlation between heart failure deaths and county poverty was due to the prevalence of diabetes and obesity in the poorest counties.
"This study underscores the disparities in healthcare faced by many Americans. As healthcare providers, we need to understand the barriers to a healthy lifestyle faced by patients, such as living in areas with no access to healthy food or safe places to walk. Understanding these barriers and helping our patients overcome them is the first step towards building trust and better serving our under-resourced communities," Jennifer Ellis, M.D., M.B.A., chief of Cardiothoracic Surgery at NYC Health and Hospitals, Bellevue in New York, New York and advisor to the American Heart Association's EmPOWERED to Serve, said.
Taking socioeconomic issues into consideration as health factors is an upstream approach to health care; it seeks to address persistent health issues at their source. As a 2008 paper in the Journal of Public Health Management and Practice on upstream healthcare states, “[Health] status is embedded in larger living and working conditions... the larger social and economic policies that impact the quality of life and the living conditions in homes and communities, as well as, the economic resources available to the household can also importantly affect health.”
The research team reviewed data from 3,000 counties. They sought potential links between heart failure deaths and several county-level factors, including education, unemployment, poverty and health insurance status. Obviously, many of these factors are related or compounding unto one another. Data was gathered from both the Centers for Disease Control and Census Bureau databases. Out of all the factors, poverty was found to have the highest correlation with heart failure deaths. A difference was discovered of approximately 250 deaths for each 100,000 between the poorest and most affluent counties. Every time the county poverty status increased by one percent, heart failure deaths increased by about five deaths per 100,000. The link was strongest in counties in the southern census region.
"Interventions to help people in poor areas, where obesity is more common, to attain and maintain a healthy body weight should be investigated in developing policies to improve heart failure outcomes across the U.S. counties," study co-author Wen-Chih Wu, M.D., chief of cardiology and research health science at the Providence VA Medical Center and associate professor of medicine at Brown University, said.
Article Sources: EurekAlert