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Financial Stress and Risk of Coronary Heart Disease in the Jackson Heart Study
Kaitlyn E Moran1, Mark J Ommerborn1, Chad T Blackshear2
1Center for Community Health and Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.
Insights
Financial stress is linked to increased coronary heart disease (CHD) risk in African Americans. Managing financial stress may be crucial for CHD prevention in this population.
Area of Science:
- Cardiovascular Disease Epidemiology
- Social Determinants of Health
- Health Disparities in African Americans
Background:
- Financial hardship is a known correlate of coronary heart disease (CHD) risk factors.
- African American communities may be disproportionately impacted by financial hardship.
- The association between financial stress and incident CHD in African Americans requires further investigation.
Purpose of the Study:
- To examine the relationship between financial stress and the incidence of coronary heart disease (CHD) in African Americans.
- To determine if perceived financial stress is an independent risk factor for CHD in this population.
Main Methods:
- Utilized data from the Jackson Heart Study, a longitudinal cohort of African Americans.
- Assessed financial stress using the Weekly Stress Inventory, categorizing it into four levels.
- Defined incident coronary heart disease (CHD) based on adjudicated events, including myocardial infarction and cardiac procedures.
Main Results:
- Individuals experiencing moderate to high financial stress had a higher likelihood of CHD events (HR=2.42).
- This association was attenuated after adjusting for depression, smoking, and diabetes.
- The study included 2,256 participants with follow-up through December 2012.
Conclusions:
- Financial stress may represent a significant, yet often unrecognized, risk factor for coronary heart disease (CHD) in African Americans.
- Future research should explore interventions targeting perceived stress and other CHD risk factors in financially stressed populations.
- Understanding the interplay of financial stress, mental health, and lifestyle factors is critical for CHD prevention.
Introduction:
Financial hardship is associated with coronary heart disease risk factors, and may disproportionately affect some African American groups. This study examines whether stress because of financial hardship is associated with incident coronary heart disease in African Americans.
Methods:
The Jackson Heart Study is a longitudinal cohort study of cardiovascular disease risks in African Americans in the Jackson, Mississippi metropolitan statistical area. Participant enrollment began in 2000. Analyses were performed in 2017 and included adjudicated endpoints through December 2012. Financial stress was assessed from the Jackson Heart Study Weekly Stress Inventory and categorized into four levels: (1) did not experience financial stress, (2) no stress, (3) mild stress, and (4) moderate to high stress. Incident coronary heart disease was defined as the first event of definite or probable myocardial infarction, definite fatal myocardial infarction, definite fatal coronary heart disease, or cardiac procedure. There were 2,256 individuals in this analysis.
Results:
Participants with moderate to high (versus no) financial stress were more likely to have incident coronary heart disease events after controlling for demographics, SES, access to care, and traditional clinical risk factors (hazard ratio=2.42, 95% CI=1.13, 5.17). The association between financial stress and coronary heart disease was no longer statistically significant in a model adjusting for three specific risk factors: depression, smoking status, and diabetes (hazard ratio=1.99, 95% CI=0.91, 4.39).
Conclusions:
Financial stress may be an unrecognized risk factor for coronary heart disease for African Americans. Additional research should examine these associations in intervention studies that address perceived stress, in addition to other coronary heart disease risk factors, in patients experiencing financial stress.
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