Your risk of developing heart disease might extend beyond genes or lifestyle choices. It may be affected by your ZIP code.

After about five decades of decline, heart disease levels are rising among some groups. In a recently released study, researchers say the increase might be tied to factors related to economic problems.

“Our study shows that large economic trends — whether it’s a significant reduction in employment or a recession — have a real impact on communities and on the cardiovascular health of people living in those communities,” said Dr. Sameed Khatana at the University of Pennsylvania School of Medicine.

Khatana and a team of researchers at the university found that middle-aged adults who live in communities that have seen the greatest economic downturn were more likely to be at risk for heart disease and strokes.

The study found that rates remained unchanged in areas with low levels of economic distress, while places with high rates of unemployment, lower median income and low levels of affordable housing saw an uptick from 122 deaths per 100,000 residents in 2010 to 127.6 deaths in 2015.

The researchers examined cardiovascular mortality rates for ages 25 to 64. They concluded that communities with the highest Distressed Community Index — which looks at seven categories of economic activity — had the highest rate of heart-related health problems and the highest increase in cardiovascular-related deaths from 2010 to 2015.

The Distressed Community Index took into account factors such as income, housing access and education level.

To determine the link between economic distress and heart disease levels, the researchers established a model that took into account factors like health insurance coverage and number of providers.

“It’s important that policymakers, physicians and even patients are aware of this increase in mortality rates. Interventions, such as policies like a health insurance expansion, may help slow this trend or even reverse it,” Khatana said.