The American Academy of Pediatrics (AAP) released a policy paper in 2016, detailing the impact of poverty on child health in America. Almost half the children in the U.S. live in poverty or near poverty. Poverty can lead to several immediate and long term health complications in children. Poverty can impact birth weight, infant mortality, language development, risk for chronic illness, nutrition status and risk of injury. The toxic stress caused by poverty can influence brain development. These major impacts of poverty, particularly on children’s heart health, were recently examined at a conference hosted by the American Heart Association (AHA).
The virtual press briefing was a joint effort between the AHA and the AAP. It was open to health journalist and offered a number of presentations from 17 organizations highlighting an AHA joint initiative, What Every Child Needs. The central focus was to highlight the importance of ensuring that every child in the U.S. has access to adequate nutrition and safe and adequate levels of physical activity. Most experts know that access to these two lifestyle elements supports good health, which indicates a need to support health equity.
In 2009, The American Journal of Epidemiology featured a study that suggested a worrisome impact of poverty on cardiac health. Long term exposure to poverty increased the risk of coronary heart disease, though the actual mechanisms were not clear. Experts noted the impact that lifelong disadvantage could have on health and the importance of heart disease prevention in the financially disadvantaged population.
The new research in Journal of the American Heart Association found a more specific heart finding. Children from socially and economically disadvantaged families seem to be more likely to develop thicker carotid artery walls, which indicates a higher risk for heart attack event in adulthood. The carotid arteries are the major blood supply to the brain. Ultrasound technology can detect early development of atherosclerosis or “hardening of the arteries” which increases the risk of cardiac events. In recent decades experts have noted that atherosclerosis, a process associated with aging and obesity, can actually begin during childhood.
The researchers compiled data – family and neighborhood socioeconomic status – from 1477 Australian families. They looked at income, education, occupation of parents and the socioeconomic status of their respective neighborhoods. Right carotid arteries of children between the ages of eleven and twelve were analyzed. Findings included:
- An association between family and neighborhood socioeconomics and carotid inner layer thickness, with family association the stronger of the two.
- The more disadvantaged the family socioeconomic position, the thicker the carotid inner lining findings. Kids whose families were in the bottom fourth at age eleven to twelve were 46 percent more likely to have a carotid thickness above the seventy fifth percentile.
- Socioeconomic position at age two or three already began to show impact in carotid artery measurements by age 11.
- The findings were independent of other cardiovascular risk factors including weight, blood pressure, and second-hand smoke exposure.
So what specifically is causing this uptick in cardiac risk? The researchers postulate that poverty is associated with a higher risk of infections and inflammation. Infections which can lead to inflammation are quite common among the disadvantaged. They don’t often have ongoing consistent healthcare, and the population is at risk of poor vaccination compliance. Malnutrition is prevalent, but so is obesity (another driver of inflammation). Not to diminish the impact of direct risk factors like high blood pressure and body weight, but the researchers suggest that the impact of poverty and socioeconomic status is clearly a separate risk factor.
Also noted in the study was the impact of socioeconomic position on infancy health and even the health of the growing fetus. Carotid artery measurements in childhood suggest that social inequality and poverty can instigate cardiovascular disease risk even before birth. Interventions that can help to limit this heart risk and improve heart health profile among all age groups include:
- Ensuring that every child has adequate, nutritious food to eat. School lunch programs, daycare food plans, programs like Women, Infants, and Children (WIC) are making inroads, but more progress is needed.
- Making sure children get adequate physical activity time from a very young age. Promoting recess time, promoting movement during class time, supporting after-school sports programs, supporting summer camp programs in this population can help.
- Consistent access to healthcare during pregnancy and then after birth, including vaccination programs and mental health support programs
It’s important to note that this was an observational study so cause and effect between socioeconomic position and carotid artery thickness is not a proven finding. The study also involved Australian families, so applying the findings to other populations will require more research. Still the research echoes other studies that found links between these two variables.
One such study that used data from the Cardiovascular Risk in Young Finns Study, published In Journal of the American Medical Association Pediatrics, found that childhood socioeconomic status was associated with left ventricular mass and diastolic function after adjusting for age, sex and other cardiac risk factors both in childhood and adulthood. Lower socioeconomic status in childhood in this study correlated with higher left ventricular mass and poorer diastolic function in adulthood.
There are so many reasons to intercept poverty. Cardiac health has now been added to the list. Given that 5.7 million adults in the U.S. have heart failure, and about half will die within five years of diagnosis, the role of poverty becomes increasingly more important and necessary to address.