Financial, community wellbeing tied to lower risk for CV death
Key takeaways:
- Wellbeing is a measurable outcome that is associated with mortality from heart disease.
- Financial and community wellbeing were the most significant elements for heart health.
U.S. counties with higher measures of community, social and financial wellbeing and greater life satisfaction had the lowest rates of CV death, with the most significant elements being financial and community health, data show.
“During a time of social upheaval and greater awareness of how social determinants of health and structural racism lead to health disparities, population wellbeing may offer a focus of immediate intervention to improve equity in cardiovascular health outcomes,” Erica S. Spatz, MD, MHS, associate professor in the section of cardiovascular medicine at Yale School of Medicine and director of the Preventive Cardiovascular Health Program at Yale/YNHH Heart and Vascular Center, and colleagues wrote in the study background. “More data demonstrating an association of wellbeing with cardiovascular outcomes could support this approach.”
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Survey data on wellbeing
In a cross-sectional, observational study, Spatz and colleagues analyzed data from 514,971 adults living in 3,228 counties across the U.S. who responded to the Gallup National Health and Wellbeing Index survey, which Gallup conducted with randomly selected adults from 2015 to 2017. The index includes five elements of wellbeing: having a successful life career, social relationships, financial security, relationship to community and good physical health. The index is scored on a scale of 0 to 100, with 0 representing the lowest wellbeing and 100 representing the highest wellbeing.
The mean age of respondents was 54 years; 48.9% were women and 76% were white. Researchers linked respondent data with county-level rates of CVD mortality from the CDC Atlas of Heart Disease and Stroke. The primary outcome was the county-level rate of total CVD mortality; secondary outcomes were mortality rates for stroke, HF, CHD, acute MI and total heart disease.
Researchers assessed the association of population wellbeing, measured using a modified version of the wellbeing index, with CVD mortality and conducted an analysis of whether the association was modified by county structural factors such as area deprivation index, income inequality and urbanicity, or population health factors, such as percentages of the adult population who had hypertension, diabetes, or obesity. Researchers also assessed population wellbeing index and its ability to mediate the association of structural factors associated with CVD.
The findings were published in JAMA Network Open.
Among all counties, the CVD mortality rate was 462 deaths per 100,000 persons.
Mortality rates for CVD decreased from a mean of 499.7 (range, 174.2-974.7) deaths per 100,000 persons in counties with the lowest quartile of population wellbeing to a mean of 438.6 (range, 110.1- 850.4) deaths per 100,000 persons in counties with the highest quartile of population wellbeing, for a difference of 61.1 deaths per 100,000 persons between the lowest and highest wellbeing index counties.
“The crude rates for CVD, stroke, heart failure, coronary heart disease, heart attack, and all heart disease mortality decreased as population wellbeing increased,” the researchers wrote.
CV deaths decrease as wellbeing increases
In an unadjusted model, the effect size of wellbeing index on CVD mortality was –15.5 (1.5; P < .001), indicating that total CV deaths decreased by 15.5 deaths per 100,000 persons for each 1-point increase of population wellbeing.
“This association was mostly mediated by deaths from all heart disease, and less from deaths from stroke,” the researchers wrote.
After adjusting for structural factors and structural plus population health factors, the association was attenuated but still significant. For each 1-point increase in wellbeing, the total CV death rate decreased by a mean of 7.3 per 100,000 persons (P < .001). All components of wellbeing were inversely associated with total CV death except anticipated life satisfaction.
In the secondary analysis of wellbeing elements, only the community and financial wellbeing elements were independently associated with CVD mortality, according to researchers.
In mediation analyses, associations of income inequality and area deprivation index with CVD mortality were partly mediated by the modified population wellbeing index.
“Our findings suggest that interventions targeting increased wellbeing could have a significant association with CVD mortality, which continues to be the leading cause of death in the U.S., accounting for 20% of all deaths,” the researchers wrote. “Results from our path analyses indicating that wellbeing mediates the association of structural risk factors with CVD mortality (ie, income inequality and the [Area Deprivation Index]) support this claim. Although the indirect associations of wellbeing with CVD mortality are small, when considered across multiple community risk factors, the attenuating impact of wellbeing could be meaningful.”
The researchers noted that targeting interventions to improve wellbeing in communities with lower socioeconomic measures could be an effective way to mitigate the increased risk for CVD death in those communities.
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