The richest 20% of Americans are ‘pulling away’ on health from the poorest 80%
A new study published today in the journal JAMA Network Open reveals startling and widening disparities in cardiovascular disease prevalence among the richest and poorest Americans. Overall, the burden of heart disease is much lower among the richest 20% of Americans compared to the poorest 80%, and this gap has swelled since 1999.
The study authors analyzed data from nine cycles of the National Health and Nutrition Examination Survey, which included over 44,900 people. They found that the prevalence of congestive heart failure in the richest 20% of Americans is less than a third of the prevalence among the poorest 80%, and that the prevalence of stroke among the richest 20% of Americans is less than half of the prevalence among the poorest 80%.
“These two conditions are important because they are associated with high out-of-pocket and health care expenditure, which adds to the disproportionate burden of cardiovascular disease in the U.S.,” says lead study author Salma M. Abdalla, MD, MPH, a research fellow at Boston University School of Public Health.
Abdalla and her research team also found that these disease disparities are growing. For example, the prevalence of angina — a type of chest pain caused by reduced blood flow to the heart — among the wealthiest 20% of Americans decreased from 3.4% in 1999 to 0.3% in 2016. During the same period, the prevalence among the poorest 80% decreased at a lower rate from 3.3% to 2.6%. Congestive heart failure and strokes also decreased among the wealthiest one-fifth of Americans while it increased among everyone else.
Income inequality in the United States has grown dramatically over the last several decades, and data has consistently shown that people with higher incomes tend to be healthier across all indicators including longevity. This is likely due to the fact, as the researchers point out in their paper, having a higher income means having greater access to resources like health care, the ability to pay for raising medication costs, stable housing, and access to healthy food.
While discussion of income inequality has historically focused on comparing the top 1% to the rest of the U.S. population, the researchers argue that a growing income gap between the top one-fifth of Americans and the rest of the U.S. is having a clear impact on health outcomes. The richest 20% of Americans are “pulling away’” on health from the poorest 80%, says Abdalla.
While the research team expected to see a disparity in heart disease prevalence among these groups, Abdalla says the scale was surprising. She adds that while it’s clear that there needs to be investments in the structural factors that drive heart disease outcomes in the U.S., “we can’t begin these investments without the knowledge that those making the decisions about such investments are most likely not affected by the overall declining in health indicators in the U.S.”
“When one-fifth of the country is doing quite well, achieving health status comparable to other high-income countries, that one-fifth of the population — which is responsible for the majority of the decisions that shape the health of Americans — has relatively little to gain by challenging the system that sustains these advantages,” she says.