The association between income disadvantage and incident heart failure differed by John Henryism level, such that for every 1-unit increase in income disadvantage score, the risk of HF increased 2-fold among Black adults with high John Henryism after full adjustment.
Key Findings
Results
A statistically significant interaction between income disadvantage and John Henryism was observed for incident heart failure.
Interaction term P=0.04 for income × John Henryism on incident HF
Analysis sample consisted of 1704 participants from the Jackson Heart Study with no cardiovascular disease at baseline (2000-2004)
Mean age was 52.15 years, 64.3% female, all Black adults from the Jackson, Mississippi Metropolitan area
100 HF events occurred by 2016 over a mean follow-up of 10 years
Models were adjusted for age, sex, and established lifestyle risk factors
Results
Among participants with high John Henryism, each 1-unit increase in income disadvantage score was associated with a 2-fold increased risk of incident heart failure after full adjustment.
Fully adjusted hazard ratio of 2.00 (95% CI, 1.39–2.86) per 1-unit increase in income disadvantage score among those with high JH
John Henryism scores (0–36) were categorized as low (<28), moderate (29–32), and high (>32)
This association persisted after adjustment for age, sex, and established lifestyle risk factors
Results
Among participants with low John Henryism, the unadjusted association between income disadvantage and heart failure attenuated to non-significance after adjustment for age and sex.
Unadjusted hazard ratio for low JH group: 1.40 (95% CI, 1.04–1.90) per 1-unit increase in income disadvantage score
After adjusting for age and sex, the association attenuated to hazard ratio 1.19 (95% CI, 0.87–1.63), which was no longer statistically significant
This contrasts with the high JH group, where the association remained significant after full adjustment
Methods
Socioeconomic disadvantage indicators included low household income, low educational attainment, and low maternal educational attainment scores, and John Henryism was assessed as a high-effort coping behavior.
SED indicators were low household income, low educational attainment, and low maternal educational attainment scores
JH scores ranged from 0 to 36 and were categorized as low (<28), moderate (29–32), and high (>32)
Effect moderation was assessed using interaction terms and stratification within proportional hazards regression models
Background
The John Henryism hypothesis posits that repeated high-effort coping with socioeconomic adversity can accelerate cardiovascular aging and increase the risk for heart failure.
Black adults experience more socioeconomic disadvantages than their White counterparts, as well as earlier onset and greater mortality from heart failure
The study was designed to test whether JH moderates the association between SED and incident HF in a Black adult cohort
The authors note that SED and high JH tend to co-occur
Glover L, DeAngelis R, Ansari M, Sims M, Brewer L, James S. (2026). Socioeconomic Disadvantage, John Henryism, and Incident Heart Failure in the Jackson Heart Study.. Circulation. Population health and outcomes. https://doi.org/10.1161/CIRCOUTCOMES.125.012740