Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet Regional Health - Americas, 101039. https://doi.org/10.1016/j.lana.2025.101039 Dr. Salma M. Abdalla et al.
Points
- The study analyzed the relationship between income, education, and cardiovascular disease (CVD) in the U.S. using NHANES data from 1999 to 2018, categorizing participants by income and education level.
- The top 20% of income earners with college degrees had the lowest prevalence of congestive heart failure (CHF), heart attacks, angina, and strokes.
- The bottom 80% income earners without college degrees had the highest rates of CVD, with CHF prevalence at 3.0% versus 0.5% in the highest-income, college-educated group.
- The odds of CVD were much higher for lower-income groups, with odds ratios ranging from 1.48 to 3.67 for college graduates and 2.36 to 6.52 for non-college graduates.
- The study underscores the impact of income and education on heart health and recommends further research to address these disparities through targeted public health interventions.
Summary
Over the past two decades, this study examined the relationship between income, education, and cardiovascular disease (CVD) outcomes in the United States. Using data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018, the analysis stratified participants into four groups based on income and education: top 20% income earners with college degrees, top 20% income earners without college degrees, bottom 80% income earners with college degrees, and bottom 80% income earners without college degrees. The study aimed to calculate the age-standardized prevalence and odds ratios of congestive heart failure (CHF), angina, heart attack, and stroke in these groups.
The findings revealed significant disparities in the prevalence of CVD outcomes between socio-demographic groups. The top 20% of income earners with college degrees had the lowest prevalence for all conditions, while the bottom 80% without college degrees had the highest prevalence. For example, the age-standardized prevalence of CHF was 0.5% in the top 20% income, college graduate group compared to 3.0% in the bottom 80% income, non-college graduate group. Similarly, the prevalence of heart attack was 1.7% in the top-income college graduate group versus 3.9% in the bottom-income, non-college graduate group. The odds of all CVD conditions were significantly higher for lower-income groups, with odds ratios (ORs) ranging from 1.48 to 3.67 for college graduates and 2.36 to 6.52 for non-college graduates compared to the top-income college graduates.
The study highlights the growing health disparities between socio-demographic groups, with significant clustering of CVD risk in those with lower income and education. The odds ratios for CHF and heart attack in the top 20% income, non-college graduate group (OR 3.11 [95% CI: 1.92, 5.06] and OR 1.92 [95% CI: 1.35, 2.73], respectively) further emphasize the intersection of income and education in shaping health outcomes. Future research should explore the mechanisms behind these disparities to inform public health strategies better.
Link to the article: https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(25)00049-3/fulltext
References Abdalla, S. M., Rosenberg, S. B., Maani, N., Melendez Contreras, C., Yu, S., & Galea, S. (2025). Income, education, and the clustering of risk in cardiovascular disease in the US, 1999–2018: An observational study. The Lancet Regional Health - Americas, 101039. https://doi.org/10.1016/j.lana.2025.101039
