Poverty Kills, New Heart Study Finds : Cardiac Disease Is Much Higher Among L.A. County’s Poor

Contrary to the common conception that the hard-driving life style of the more affluent make them prime candidates for heart disease, it is the poor in Los Angeles County who are more likely to develop the illness and die from it, according to a new study released Wednesday.

The study, funded by the American Heart Assn., examined the mortality rates from heart disease and from all other causes of death in each of the county’s 136 communities during 1979-81. Those rates were then analyzed according to sex, race-ethnicity and five annual income brackets ranging from less than $13,750 to more than $28,500.

The investigators found that poor males as a group, regardless of race, are almost 40% more likely to die of heart disease than wealthier males. Among women, the rate was 27% higher when comparing the poor to the more affluent.

Variations in Rates

The overall death rates varied from 460 per 100,000 population for the lowest income group to 329 per 100,000 for those in the highest income group of $28,500 or more.

“It is not affluence that apparently kills individuals (from heart disease), but poverty,” said Dr. Ralph R. Frerichs, a UCLA School of Public Health epidemiologist who was a principal investigator in the study.

Frerichs’ study was a follow-up to an earlier heart association report in September, 1983, which showed that blacks in Los Angeles County have the highest mortality rates from heart disease.

But the earlier study did not consider the differences in income among various racial and ethnic groups. When those factors were added for the present study, the results showed that the high death rate from heart disease in blacks was primarily confined to those who were poor.

Black Males Compared

Dr. Michael Wong, president of the heart association’s Greater Los Angeles affiliate, said that black males making an annual income of $13,750 or less are 53% more likely to die of heart disease than black males in the $28,500-a-year or higher income levels.

Poor black females are 33% more likely to die of heart disease than wealthier black women.

“There is no consistent difference between blacks and all others in the risk of dying due to the major cardiovascular diseases, once we have controlled for the effects of income,” the report said.

Frerichs said he believes that the findings in general, although obtained from Los Angeles County residents, apply to the nation as a whole.

“People in Los Angeles are similar to people elsewhere in the U.S.,” he said. “The typical resident of Los Angeles is not that different from ones in Des Moines, Iowa, or New York City.”

When trends in the three leading causes of death in Los Angeles County are compared to the United States, the rate for heart disease is slightly lower in the county. For the next two leading causes of death--cancer and stroke--the county and national rates are nearly identical, although Los Angeles County residents in the last several years have been slightly more likely to die of a stroke.

Control of Risk Factors

Frerichs speculated that a possible reason for the greater vulnerability of poor people may be related to the greater awareness among wealthier and better educated residents of the need to control heart disease risk factors. Those factors include high blood pressure, cigarette smoking, lack of exercise and dietary factors.

It is conceivable, he said, that food programs for the poor may have led them to consume the kinds of foods that are believed to lead to a high risk of developing heart disease.

“We need to do more research to look at the risk factors for the rich and the poor, to see if they are higher in the poor and also to see whether access to health facilities is different,” the researcher said.

Looking at the death rates for the non-black population, Frerichs found that of all Asian residents in the county, the Japanese had the highest mortality rates from both heart disease and stroke. Japanese males were found almost as likely to die of stroke as black males, who had the highest risk of all.

For each racial-ethnic group regardless of income, the death rates for all major cardiovascular diseases are: non-Latino white, 418 per 100,000 population; black, 459; Latino, 370; Japanese, 239; Chinese, 193, and Korean, 142.

Another major finding in the study, according to Wong and Frerichs, is that of all deaths that occurred outside of a hospital, the highest percentage was among the poor.

“The location of death is important because it may indicate how health resources are utilized and, indirectly, the availability of care,” the report stated. “The assumption is made that a person has a better chance of survival if care is administered in a hospital or other health facility prior to the expected time of death.”

Thirty-six percent of deaths from heart disease among blacks were found to have occurred outside a hospital. The rate for whites was 26%. The lowest rate was 20% for the Chinese.

Community Differences

The researchers found striking differences in the percentages of out-of-hospital deaths when looked at by community. The highest rates occurred in the downtown area, with 51%; the Avalon neighborhood of South-Central Los Angeles, 44%; the Main Street neighborhood to the south of downtown, 43%, and Watts, 40%.

But surprisingly, a number of affluent communities also showed higher-than-average rates for out-of-hospital deaths from heart disease. The rate for Bel-Air, for example, was 31%; for Hollywood Hills-Griffith Park, 30%; Westchester, 29%; San Marino-South Pasadena and Granada Hills, 28%, Palos Verdes Estates, 23%.

Frerichs offered no explanation for this finding except the possibility that it may have to do with the availability of emergency care.

“We’ve provided the descriptive material. Now we hope that physicians, government and others will realize the differences that exist and look into them further,” he said.

The other members of the research team were Dr. John M. Chapman and Parivash Nourjah and Edmond F. Maes.