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Invited Commentary
October 9, 2019

The Influence of Social and Economic Factors on Heart Disease

Author Affiliations
  • 1Department of Medicine, Denver Health, Denver, Colorado
  • 2Division of Cardiology, Department of Medicine, University of Colorado School of Medicine
JAMA Cardiol. Published online October 9, 2019. doi:https://doi.org/10.1001/jamacardio.2019.3802

According to data from the National Center for Health Statistics, the long-term trend toward rising life expectancy in the United States has stalled in the past decade. Life expectancy at birth was 78.9 years in 2014 and has worsened every year since; it was 78.6 years in 2017. While so-called deaths of despair from drug and alcohol use and from suicide are major factors in this worsening, the decline in the age-adjusted death rate from cardiovascular disease (CVD) that began in the 1970s has stalled in the same time frame, with no statistically significant change between 2016 and 2017 and an actual increase between 2014 and 2015. Deterioration in the quality of medical care is an implausible explanation for these trends, so attention has been turned increasingly toward social determinants of health as the cause. In this view, increased risk for chronic noncommunicable illnesses, such as CVD, falls on those with lesser socioeconomic positions as judged by factors such as educational attainment, income/wealth, race/ethnicity, and political voice.1

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