Socioeconomic status ‘uneven predictor’ of heart health by race, ethnicity
Key takeaways:
- Compared with white adults, other races and ethnicities have a lower association of socioeconomic status with CV health measures.
- Improving socioeconomic status may have different magnitudes of effect by race.
The association of socioeconomic status with CV health measures is strongest among white adults vs. adults from other racial groups in the U.S., suggesting health policies must address other social factors that are driving inequality.
“Socioeconomic status, defined as education, income, employment status and health insurance, appears to be an uneven predictor of heart health, with white adults benefiting the most in comparison with Black, Hispanic and Asian Americans,” Amaris Williams, PhD, research scientist in the division of endocrinology, diabetes and metabolism at Ohio State University College of Medicine, told Healio.

Data show higher socioeconomic status is linked to higher attainment of CV health as defined by the American Heart Association’s Life’s Essential 8, which are eight risk factors for heart disease that include BP, glucose, cholesterol, BMI, physical activity, dietary intake, smoking status and sleep. In the U.S., Black adults have the lowest Life’s Essential 8 scores compared with people from other racial and ethnic groups, and researchers continue to examine possible reasons why.
Associations between income, education and health differ

Williams, Joshua Joseph, MD, MPH, FAHA, associate professor of internal medicine at Ohio State University College of Medicine, and colleagues analyzed data from 13,529 adults who completed the National Health and Nutrition Examination Survey across four waves from 2011 to 2018 and had available data for all components of Life’s Essential 8 score and socioeconomic status variables. The median age of participants was 48 years; 51% were women; 69% were white, 15% were Hispanic; 11% were Black and 5% were Asian. Researchers estimated the association of four socioeconomic status categories — education, income-to-poverty line ratio, employment and insurance status — with Life’s Essential 8 score.
The findings were published in the Journal of the American Heart Association.
For each socioeconomic status metric, data show the greatest variation in Life’s Essential 8 scores was seen among white adults.
“For example, the spread between Life’s Essential 8 scores seen between levels of employment status among white adults is 17 points,” the researchers wrote. “Among Black adults, the employment-level-based variation in Life’s Essential 8 scores is only 10 points.”
For education, the change in Life’s Essential 8 scores associated with college or more vs. high school or less was highest among white adults (mean score increase, 15.4; 95% CI, 13.9-16.8), followed by Hispanic adults (10; 95% CI, 7.5-12.5), Black adults (9.7; 95% CI, 7.8-11.7), and Asian adults (7.7; 95% CI, 5-10.5; P for all interactions < .05).
For income, the increase in Life’s Essential 8 score associated with a 1-point increase in income-to-poverty line ratio was highest for white adults (2.9; 95% CI, 2.4-3.3), followed by Black adults (1.8; 95% CI, 1.4-2.2), Asian adults (1.5; 95% CI, 0.9-2.2) and Hispanic adults (1.6; 95% CI, 1.1-2.1; P for interaction for all comparisons = .001).
Additionally, compared with racial and ethnic minority groups, white adults had a greater magnitude of association between some insurance statuses and Life’s Essential 8 score. Researchers found that white adults with Medicaid insurance compared with private insurance had a greater magnitude of negative association with CV health compared with all other race groups.
Consider roles of racism, stress, opportunity gap
“Current public health interventions and societal policies and programs target socioeconomic status — improving employment and education, which improves income, and increasing access to high-quality health insurance,” Williams told Healio. “The goal is that policies that improve socioeconomic status will lead to improvements in health. The current study shows improvements in socioeconomic status may not benefit all racial/ethnic groups equally, suggesting that some minoritized groups may require multifactor interventions that target other social drivers of health in addition to socioeconomic status to achieve equitable results.”
The researchers noted that a number of factors including racism, the wealth gap, stress, medical mistrust and the opportunity gap likely all play a role in the findings, and Joseph said more research is needed to best determine how to unravel these complex issues.
“The data we examined were cross-sectional, meaning everything was collected at one point in time,” Joseph told Healio. “The next step is to evaluate populations with socioeconomic status and CV health measured over many years to understand how changes in socioeconomic status over time drive changes in CV health as measured by Life’s Essential 8. We also would like to understand what factors drive differential attainment of Life’s Essential 8 at higher and lower levels of socioeconomic status, as these factors will be critical to address through interventions.”
For more information:
Joshua J. Joseph, MD, MPH, can be reached at joseph.117@osu.edu.