Daily Dose: Association of Population Wellbeing with Cardiovascular Outcomes

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on a study published in JAMA Network Open that examined the association of population-level measures of wellbeing with rates of mortality from cardiovascular disease (CVD) in the US.

The study

Investigators conducted a cross-sectional study and linked data from the Gallup National Health and Well-Being Index (WBI) sruvey to county-level rates of CVD mortality from the Centers for Disease Control and Prevention Atlas of Heart Disease and Stroke. Gallup conducted the WBI survey among randomly selected US adults aged ≥18 years from 2015 to 2017 (analyzed from August 2022 to May 2023).

The WBI is comprised of 5 elements of wellbeing and scored on a scale of 0 to 100, with 0 being the lowest well-being and 100 being the highest. The 5 elements:

1. having a successful life career

2. social relationships

3. financial security

4. relationship to community

5. good physical health

The study's primary outcome was the county-level rate of total CVD mortality; secondary outcomes were mortality rates for stroke, heart failure (HF), coronary heart disease, acute myocardial infarction (MI), and total heart disease.

The findings

Overall, the team observed wellbeing scores that were “marginally but statistically lower” among counties where income inequality was greater, and deprivation was more pronounced. Wellbeing scores were similarly lower in counties where rates of hypertension, diabetes, physical inactivity, obesity, and smoking were higher.

Population wellbeing was inversely associated with CVD mortality rate with the overall mortality rate reported as 462 deaths per 100 000 persons.

Reporting on the primary outcome, researchers found that CVD mortality rates decreased from a mean of 499.7 (range, 174.2-974.7) deaths/100 000 in counties with the lowest quintile of population wellbeing to 438.6 (range, 110.1-850.4) deaths/100 000 in counties where population wellbeing was in the highest quintile—a difference of 61.1 deaths/100 000 between counties with the highest and lowest WBI values.

The effect size of WBI on CVD mortality before adjustment was −15.5 (1.5; P< .001), ie, a decrease of 15 deaths/100 000 persons for each 1-point increase of population wellbeing. Deaths from all heart disease were identified as mediating the association and stroke to a lesser degree.

A note from authors

"These findings suggest that population well-being is a measurable and modifiable metric that may offer a focus of immediate intervention to improve cardiovascular health outcomes."

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