The old saying is that money can’t buy happiness, but can more cash lead to better heart health?

It’s long been established that higher income levels lead to greater access to care and better health outcomes. And it’s equally well-known that income disparity between those with the most resources and the remainder of the population in the U.S. has dramatically widened over the past few decades.

Researchers at Boston University focused on one piece of this picture: the differences in cardiovascular disease rates between those in the top 20% and everyone else, and whether this could provide insights into how to improve cardiovascular health among all adults in the U.S.

Using the National Health and Nutrition Examination Survey, the researchers looked at nearly 45,000 people and found that for those in the higher-income brackets, reports of angina, or chest pain, as well as for heart attack and congestive heart failure fell from more than 3% in 1999 to less than 1% in 2016. Many people in the rest of the population reported more modest reductions in rates of cardiovascular risks, but the rates of congestive heart failure and stroke increased in the lower-income group.

Congestive heart failure and stroke are associated with high out-of-pocket expenses, which can be enormous burdens for lower-income adults. They also are major drivers in the U.S. for overall health care expenditures, suggesting that these widening income and health risk disparities are playing significant roles in the ever-increasing costs in our health care system.

The findings call for greater urgency for leaders to develop a more equitable system of health care. After all, we’re all in this together.