Across 1,982 U.S. counties, pediatric poverty emerged as the single strongest county-level predictor of cardiovascular mortality (Spearman ρ=0.612), outperforming family childhood poverty (ρ=0.603), overall poverty (ρ=0.524), and all unemployment measures tested (overall ρ=0.209). Geographic disparities were stark: the East South Central division recorded 348.5 cardiovascular deaths per 100,000 residents versus just 233.9 in the Mountain division — a nearly 50% gap tied closely to child poverty concentration.
This finding reframes how public health agencies might triage cardiovascular risk. Unemployment has historically been the go-to economic indicator for targeting interventions, but this analysis suggests that where children grow up poor, adults later die of heart disease at disproportionately high rates. The mechanism is biologically plausible: chronic childhood poverty drives toxic stress, poor nutrition, limited healthcare access, and elevated allostatic load — all of which accelerate cardiovascular pathology decades later. The work aligns with the "developmental origins" literature linking early-life adversity to adult cardiometabolic disease, but this is one of the first nationwide ecological analyses to isolate pediatric poverty as the dominant county-level signal.
Critical limitations must be noted: this is an ecological cross-sectional design — individual-level causal inference is impossible and ecological fallacy applies. Confounders such as race, diet, healthcare density, and climate are not fully adjusted. As a preprint not yet peer-reviewed, results require independent validation before informing policy. Still, the consistent signal across sensitivity analyses makes this a meaningful, policy-relevant confirmatory contribution to cardiovascular social determinants research.
