Socioeconomic status and coronary heart disease risk prediction.

Abstract

Achieving the Healthy People 2010 goal of reducing health disparities has been challenging. Disparity in life expectancy by socioeconomic status (SES) has been increasing.1 Much of this disparity is attributable to higher cardiovascular, particularly coronary heart disease (CHD), mortality among persons of lower SES. Disparities in CHD mortality result from multiple factors, including early life environment and material disadvantage,2 social and behavioral risk factors,3 access to care,4 and systematic underestimation of risk among persons with lower SES in clinical care. This Commentary addresses the importance of SES in CHD risk assessment. Current risk-based intervention strategies ignore the independent contribution of SES to CHD and thus may contribute to increasing SES disparities. If CHD risk is better estimated among the poor, it could lead to increased statin use for cholesterol reduction and aspirin use for CHD prevention among this population, which may reduce CHD disparities.