Historical Origins of a Major Killer : Cardiovascular Disease in the American South

Many studies by social scientists view heart disease as the outcome of current or recent conditions such as poverty, smoking, and obesity. Here we apply an alternative approach to understand cardiovascular disease (CVD) death rates, which are elevated for southern whites relative to the rest of the county. In the developmental origins hypothesis CVD vulnerability follows from unbalanced physical development created by poor conditions in utero that underbuilds major organs such as the kidneys and the cardiovascular system relative to those needed to process lush nutrition later in life. The South underwent an economic transformation from generations of poverty to rapid economic growth in the post-WWII era, exposing many children born in the 1950s through the 1980s to unbalanced physical development. Here we use state-level data for whites on income growth, smoking, obesity and education to explain variation in CVD death rates in 2010-2011. Our proxy for unbalanced physical growth, the ratio of median household income in 1980 to that in 1950, has a large systematic influence on CVD mortality, an impact that increases dramatically with age. The income ratio combined with smoking, obesity, and education explains two thirds of the variance in CVD mortality across states. Metaphorically, persistent intergenerational poverty loads the gun and rapid income growth pulls the trigger on CVD