Poverty, chronic inflammation have ‘synergistic’ impact driving all-cause, cancer mortality
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Key takeaways:
- Poverty, combined with high levels of inflammation, was associated with elevated 15-year mortality risks.
- Screening for elevated C-reactive protein could reduce future disease and mortality.
Poverty and chronic inflammation together may have a “synergistic” impact leading to higher all-cause mortality, including a 127% increased heart disease mortality risk and a 196% higher risk for cancer mortality, according to data.
“Clinicians need to consider the effect of inflammation on people’s health and longevity, especially on those experiencing poverty,” Arch G. Mainous III, PhD, lead author of the study and a professor at the University of Florida, said in a press release.
“It’s important for guidelines panels to take up this issue to help clinicians integrate inflammation screening into their standard of care, particularly for patients who may have factors that place them at risk for chronic inflammation, including living in poverty,” he added. “It is time to move beyond documenting the health problems that inflammation can cause, to trying to fix these problems.”
To examine the potentially synergistic impact chronic inflammation and poverty have on the 15-year all-cause, heart disease and cancer mortality risk in U.S. adults, Mainous and colleagues analyzed data from the National Health and Nutrition Examination Survey from 1999 to 2002, as well as the National Death Index. A total of 4,849 U.S. adults aged 40 years and older were classified into four groups: above poverty/low inflammation (n = 2,287), above poverty/elevated inflammation (n = 1,766), poverty/low inflammation (n = 389) and poverty/elevated inflammation (n = 407).
The researchers assessed each group’s 15-year risk for all-cause, cancer and heart disease mortality using Cox regressions, adjusted for age, sex and race/ethnicity. They then performed two analyses with different definitions of high inflammation — elevated C-reactive protein greater than 0.3 mg/dl, which the CDC and American Heart Association recommend, and elevated C-reactive protein greater than 1 mg/dl, which is “consistent with systemic inflammation,” the researchers wrote. Poverty status was derived based on whether an individual was living below the poverty line at baseline from 1999 to 2002.
According to the researchers, when inflammation was defined as C-reactive protein greater than 1 mg/dl, those living above poverty with low inflammation demonstrated the lowest mortality risk over 15 years, while those in poverty with high inflammation had the highest risk (adjusted HR = 2.45; 95% CI, 1.64-3.67). Compared with people without inflammation or not living poverty, those living in poverty with high inflammation demonstrated 127% and 196% higher 15-year risks for mortality from heart disease and cancer, respectively, under the narrower definition of high inflammation.
Mainous and colleagues, who published their findings in Frontiers in Medicine, concluded that poverty and inflammation, when C-reactive protein is above 1 mg/dl, can combine to drive mortality higher than might be expected from an “additive” effect — a finding that is especially concerning for socially disadvantaged, medically vulnerable patients, they said.
“We found that participants with either inflammation or poverty alone each had about a 50% increased risk in all-cause mortality,” said coauthor Frank A. Orlando, MD, of the University of Florida, in the release. “In contrast, individuals with both inflammation and poverty had a 127% increased heart disease mortality risk and a 196% increased cancer mortality risk.
“If the effects of inflammation and poverty on mortality were additive, you’d expect a 100% increase in mortality for people where both apply,” he added. “But since the observed 127% and 196% increases are much greater than 100%, we conclude that the combined effect of inflammation and poverty on mortality is synergistic.”
The researchers recommended that targeted screening for elevated C-reactive protein in vulnerable populations “might be particularly useful.”
“Even though both inflammation and poverty are modifiable risk factors, in clinical practice, chronic diseases associated with inflammation like cardiovascular disease are more likely to be prevented by healthy lifestyle than be reversed,” they wrote.
References:
Living in poverty with chronic inflammation significantly increases heart disease and cancer mortality risk, study finds. https://www.eurekalert.org/news-releases/1030847?. Published Jan. 16, 2024. Accessed Jan. 11, 2024.
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