Socioeconomic Pressures and Clinical Gains in Heart Disease, With Suyog Mokashi, MD

A pair of economic analyses has recently revealed that, although the healthcare sector has grown substantially since 2000, the steady rise in heart disease is also driven by a variety of socioeconomic pressures.1,2

Both studies were presented at the American College of Cardiology (ACC) Scientific Sessions 2026 in New Orleans, Louisiana, by Suyog Mokashi, MD, director of strategy at the Temple Heart and Vascular Institute, director of aortic and endovascular surgery in the Division of Cardiovascular Surgery at Temple University, and co-author on both studies.

The first study examined variations in heart disease mortality rates between the South and West of the US – particularly, the role of socioeconomic factors in driving these differences. Mokashi and colleagues selected Alabama, with persistently high mortality, poverty, and limited insurance expansion, and California, with lower mortality and stronger economic and coverage indicators.1

“What our data shows is that, for the state as a whole, California has less heart disease mortality than Alabama,” Mokashi told HCPLive in an exclusive interview. “That’s not completely surprising, but if we look at per income, down to the county level, we actually found that the mortality is higher in Alabama than it is in California.”

Mokashi and colleagues connected country-level, age-adjusted heart disease mortality rates from 2022 – sourced from the Center for Disease Control (CDC) National Vital Statistics System (NVSS) – with socioeconomic data collected from the US Census Bureau American Community Survey from 2018-2022. The team included variables of race, sex, poverty, insurance coverage, and household income distribution. Additionally, multivariable linear mixed-effects models with county random intercepts were utilized to assess associations between mortality and socioeconomic variables such as interactions between poverty, income, and state.1

Ultimately, counties in Alabama reflected significantly higher cardiovascular mortality rates than those in California (P <.001). Mokashi and colleagues found substantial race and gender effects differing between states, based on multivariable regression (all P <.0001). Socioeconomic effects were also state-dependent, with $50-100k income reducing mortality in Alabama while poverty increased it. Mortality was also higher in males vs females and Blacks vs Whites. County-wide variance was greater in Alabama.1

The second study, examining long-term spending patterns for coronary atherosclerosis through the lens of US economic and healthcare sector expansion, analyzed data from 2000-2021 via National Income and Product Accounts (NIPA) estimates. Mokashi and colleagues benchmarked spending against gross output for all US industries as a proxy for gross domestic product (GDP) and the Healthcare & Social Assistance sector via Bureau of Economic Analysis data from 1997-2024. Outcomes included per capita spending, NIPA expenditures, uncontrolled expenditures, number of episodes, and cost per case.2

Mokashi and colleagues determined that, from 2000-2021, all major economic indicators declined substantially. Per capita spending on coronary atherosclerosis declined by 41 (slope -$1.86/year; P <.0001). Annually coronary atherosclerosis episodes also decreased by 136,874 (P <.0001), while NIPA expenditures and uncontrolled expenditures decreased by $381.6 million and $288.4 million per year, respectively. Additionally, coronary atherosclerosis spending lowered from 0.17% of GDP in 2000 to 0.06% in 2021.2

“So, what we’re seeing overall is that our cardiologists have done such a good job of prevention that we’re seeing less and less patients who end up being admitted with coronary artery disease and are treated for that in an inpatient setting,” Mokashi said.

Editors’ Note: Mokashi reports no relevant disclosures.

References

1. Alcudia A, Whitman I, Lu X, et al. Poverty and Income Effects Translate to Mortality in Heart Disease: Divergent Socioeconomic Gradients in the South and West. Abstract presented at the American College of Cardiology Scientific Sessions 2026, New Orleans, LA. March 28-30, 2026.

2. Gupta A, Joshi P, Zhao H, et al. Declining Burden of Coronary Atherosclerosis Reflects Clinical Gains and Healthcare Sector Growth. Abstract presented at the American College of Cardiology Scientific Sessions 2026, New Orleans, LA. March 28-30, 2026.