Developmental Origins of Cardiovascular Disease: Understanding High Mortality Rates 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. An alternative approach gaining recognition is developmental origins of health and disease, which we apply to understand high death rates of whites in the South from cardiovascular disease (CVD). In this interpretation 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 average 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.