Heart disease mortality is on the rise in California, accelerated by socioeconomic disparities that disproportionately impact marginalized communities, according to a study being presented at ACC Quality Summit 2025 taking place October 14 – 16 in Denver. It’s crucial to align prevention with equity and implement data-driven, community-focused interventions that address this heightened cardiovascular burden in low-income communities, the authors said.
“By using state and federal data, I wanted to identify which risk factors such as hypertension, diabetes, obesity, and smoking remain inadequately addressed by existing interventions,” said Ryan Nazari, the study’s lead author and an independent researcher based in Modesto, California. “The purpose was not only to measure disparities but also to highlight gaps where current strategies fall short.”
The researchers used data from the CDC WONDER database, the California Department of Public Health and peer-reviewed studies to analyze trends in cardiovascular disease burden across several California counties. The study focused on county-level mortality, income, and prevalence of comorbidities, like hypertension and diabetes, between 2018-2022.
The results found heart disease mortality increased from 141 deaths per 100,000 people in 2018 to 147.8 deaths per 100,000 people in 2020-2021. Low income, advanced age and male gender had a particularly strong impact on a region’s mortality rate. High rates of hypertension, obesity and diabetes were associated with a higher risk of heart disease mortality.
The mortality rates varied significantly based on the average income of each county. For example, Marin County maintained an average income of $142,785 and had a morality rate of 44 per 100,000 people, while Fresno County had an average income of $71,434 and had a 105.5 mortality rate. Similarly, Kern County maintained an average income of $67,660 and had an 89.2 mortality rate.
“Even though California overall has seen improvements in some cardiovascular health indicators, several counties continue to experience disproportionately high rates of disease and related risk factors,” Nazari said. “These differences highlight that statewide progress has not been consistent, and that interventions must be better tailored to the needs of communities with higher burdens of heart disease.”
Heart disease prevention must address systemic barriers in low-income communities to mitigate these higher cardiovascular risks, the researchers said. Nazari recommended implementing community-based interventions that prioritize expanding education on nutrition, exercise and preventive care and enhanced accessibility to screenings and treatment in underserved areas. Additionally, introducing policy measures that address social drivers of health, such as income inequality and food insecurity, could help alleviate the cardiovascular mortality burden in these high-risk communities.
“I expected to see variation between counties, but I was surprised at how strongly socioeconomic differences correlated with higher heart disease burden. The data showed that inequities are both persistent and widespread, which emphasizes the need for solutions that reach beyond standard medical care,” Nazari said.
While this study focused on California, the authors believe that the findings could resonate more broadly across the United States.
“Many states face similar challenges of rising heart disease burden and uneven access to preventive resources. Because California is large and diverse in terms of socioeconomic conditions and population size, it can act as a useful case study for how health disparities appear elsewhere,” Nazari said.
The American College of Cardiology (ACC) is a global leader dedicated to transforming cardiovascular care and improving heart health for all. For more than 75 years, the ACC has empowered a community of over 60,000 cardiovascular professionals across more than 140 countries with cutting-edge education and advocacy, rigorous professional credentials, and trusted clinical guidance. From its world-class JACC Journals and NCDR registries to its Accreditation Services, global network of Chapters and Sections, and CardioSmart patient initiatives, the College is committed to creating a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at www.ACC.org or connect on social media at @ACCinTouch.
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