Background: Higher well-being at the population level (collective well-being, CWB) is associated with better cardiovascular (CV) health at the population level. This study investigates the directionality of related associations among CWB, cardiovascular disease incidence and mortality (CVD/CVM), healthy behaviors and societal factors.

Methods: Using county-level U.S. data (2010-2017) from the Gallup National Health and Well-Being Index and CDC Interactive Atlas of Heart Disease and Stroke, we employed cross-lagged time-series models to assess temporal relationships among CVD/CVM, exercise frequency, diet quality, civic engagement and CWB at the population level.

Results: Analysis of 3337 counties over 8 years revealed that lower CVD and CVM consistently predicted higher CWB in the following year, the lagged effect of cardiovascular health on well-being was approximately ten times larger than the lagged effect of well-being on cardiovascular health (overall P-values < 0.001). In addition, higher levels of civic engagement and better self-rated health preceded increased CWB. Lower CVD preceded increases in civic engagement, self-rated health, higher rates of exercise engagement and better diet.

Conclusion: This study found that population level CV health is a precursor to CWB, with factors such as self-rated health and civic engagement acting as potential mediators. Efforts to improve CV health – as well as overall health and social health – of whole populations could support improvements in CWB