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Soares ARDS, Fonseca MLV, Malta DC, Chalub LLFH, Ferreira RC. Decrease in Socioeconomic Disparities in Self-Rated Oral Health among Brazilian Adults between 2013 and 2019: Results from the National Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1198. [PMID: 39338081 PMCID: PMC11431346 DOI: 10.3390/ijerph21091198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 09/06/2024] [Accepted: 09/08/2024] [Indexed: 09/30/2024]
Abstract
This cross-sectional study assessed the magnitude of inequalities in self-rated oral health (SROH) among different socioeconomic groups in Brazil. Secondary data from interviews with a sample of adults (≥18 years) from the national health survey 2013 (n = 64,308) and 2019 (n = 88,531) were analyzed. Positive SROH was considered when participants selected the good or very good options. Socioeconomic indicators were monthly household income and years of education. The magnitude of inequalities among socioeconomic groups was estimated using the Slope (SII) and Relative Index of Inequality (RII). Interaction term assessed changes in SII/RII over time. Estimates were adjusted for sex and age. The prevalence of SROH was 67.50% in 2013 and 69.68% in 2019. Individuals with lower socioeconomic indicators had a lower prevalence of positive SROH. Significant reductions in the magnitude of the education-based RII between 2013 (1.58) and 2019 (1.48) in Brazil, as well as in north (1.70; 1.45) and northeast (1.50; 1.41) regions and reduction in the income-based RII in the north (1.71; 1.51) were observed. Socioeconomic inequalities in SROH persist across different Brazilian regions, although there was a reduction in disparities among education groups in 2019 compared with 2013. The findings of this study suggest that equitable Brazilian oral health policies may have contributed to reducing SROH inequality over time.
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Affiliation(s)
- Anna Rachel dos Santos Soares
- Department of Social and Community Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (A.R.d.S.S.); (M.L.V.F.); (L.L.F.H.C.)
| | - Maria Luiza Viana Fonseca
- Department of Social and Community Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (A.R.d.S.S.); (M.L.V.F.); (L.L.F.H.C.)
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
| | - Loliza Luiz Figueiredo Houri Chalub
- Department of Social and Community Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (A.R.d.S.S.); (M.L.V.F.); (L.L.F.H.C.)
| | - Raquel Conceição Ferreira
- Department of Social and Community Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (A.R.d.S.S.); (M.L.V.F.); (L.L.F.H.C.)
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Deng K, Gupta DK, Shu XO, Lipworth L, Zheng W, Cai H, Cai Q, Yu D. Circulating Metabolite Profiles and Risk of Coronary Heart Disease Among Racially and Geographically Diverse Populations. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2024; 17:e004437. [PMID: 38950084 PMCID: PMC11335450 DOI: 10.1161/circgen.123.004437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 05/17/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Metabolomics may reveal novel biomarkers for coronary heart disease (CHD). We aimed to identify circulating metabolites and construct a metabolite risk score (MRS) associated with incident CHD among racially and geographically diverse populations. METHODS Untargeted metabolomics was conducted using baseline plasma samples from 900 incident CHD cases and 900 age-/sex-/race-matched controls (300 pairs of Black Americans, White Americans, and Chinese adults, respectively), which detected 927 metabolites with known identities among ≥80% of samples. After quality control, 896 case-control pairs remained and were randomly divided into discovery (70%) and validation (30%) sets within each race. In the discovery set, conditional logistic regression and least absolute shrinkage and selection operator over 100 subsamples were applied to identify metabolites robustly associated with CHD risk and construct the MRS. The MRS-CHD association was evaluated using conditional logistic regression and the C-index. Mediation analysis was performed to examine if MRS mediated associations between conventional risk factors and incident CHD. The results from the validation set were presented as the main findings. RESULTS Twenty-four metabolites selected in ≥90% of subsamples comprised the MRS, which was significantly associated with incident CHD (odds ratio per 1 SD, 2.21 [95% CI, 1.62-3.00] after adjusting for sociodemographics, lifestyles, family history, and metabolic health status). MRS could distinguish incident CHD cases from matched controls (C-index, 0.69 [95% CI, 0.63-0.74]) and improve CHD risk prediction when adding to conventional risk factors (C-index, 0.71 [95% CI, 0.65-0.76] versus 0.67 [95% CI, 0.61-0.73]; P<0.001). The odds ratios and C-index were similar across subgroups defined by race, sex, socioeconomic status, lifestyles, metabolic health, family history, and follow-up duration. The MRS mediated large portions (46.0%-74.2%) of the associations for body mass index, smoking, diabetes, hypertension, and dyslipidemia with incident CHD. CONCLUSIONS In a diverse study sample, we identified 24 circulating metabolites that, when combined into an MRS, were robustly associated with incident CHD and modestly improved CHD risk prediction beyond conventional risk factors.
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Affiliation(s)
- Kui Deng
- Vanderbilt Epidemiology Center, Division of Epidemiology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Deepak K. Gupta
- Vanderbilt Translational and Clinical Cardiovascular Research Center & Division of Cardiovascular Medicine, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Xiao-Ou Shu
- Vanderbilt Epidemiology Center, Division of Epidemiology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Loren Lipworth
- Vanderbilt Epidemiology Center, Division of Epidemiology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Wei Zheng
- Vanderbilt Epidemiology Center, Division of Epidemiology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Hui Cai
- Vanderbilt Epidemiology Center, Division of Epidemiology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Qiuyin Cai
- Vanderbilt Epidemiology Center, Division of Epidemiology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Danxia Yu
- Vanderbilt Epidemiology Center, Division of Epidemiology, Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Darvish S, Mahoney SA, Venkatasubramanian R, Rossman MJ, Clayton ZS, Murray KO. Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions. J Appl Physiol (1985) 2024; 137:194-222. [PMID: 38813611 PMCID: PMC11389897 DOI: 10.1152/japplphysiol.00188.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 05/31/2024] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.
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Affiliation(s)
- Sanna Darvish
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Sophia A Mahoney
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | | | - Matthew J Rossman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Kevin O Murray
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, United States
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Salgado MV, Penko J, Fernández A, Rios-Fetchko F, Coxson PG, Mejia R. The burden of premature coronary heart disease among adults with low socioeconomic status in Argentina: A modeling study. PLoS One 2024; 19:e0305948. [PMID: 38913678 PMCID: PMC11195980 DOI: 10.1371/journal.pone.0305948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 06/07/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND The well-established inverse relationship between socioeconomic status (SES) and risk of developing coronary heart disease (CHD) cannot be explained solely by differences in traditional risk factors. OBJECTIVE To model the role SES plays in the burden of premature CHD in Argentina. MATERIALS AND METHODS We used the Cardiovascular Disease Policy Model-Argentina to project incident CHD events and mortality in low and high-SES Argentinean adults 35 to 64 years of age from 2015 to 2024. Using data from the 2018 National Risk Factor Survey, we defined low SES as not finishing high-school and/or reporting a household income in quintiles 1 or 2. We designed simulations to apportion CHD outcomes in low SES adults to: (1) differences in the prevalence of traditional risk factors between low and high SES adults; (2) nontraditional risk associated with low SES status; (3) preventable events if risk factors were improved to ideal levels; and (4) underlying age- and sex-based risk. RESULTS 56% of Argentina´s 35- to 64-year-old population has low SES. Both high and low SES groups have poor control of traditional risk factors. Compared with high SES population, low SES population had nearly 2-fold higher rates of incident CHD and CHD deaths per 10 000 person-years (incident CHD: men 80.8 [95%CI 76.6-84.9] vs 42.9 [95%CI 37.4-48.1], women 39.0 [95%CI 36.-41.2] vs 18.6 [95%CI 16.3-20.9]; CHD deaths: men 10.0 [95%CI 9.5-10.5] vs 6.0 [95%CI 5.6-6.4], women 3.2 [95%CI 3.0-3.4] vs 1.8 [95%CI 1.7-1.9]). Nontraditional low SES risk accounts for 73.5% and 70.4% of the event rate gap between SES levels for incident CHD and CHD mortality rates, respectively. DISCUSSION CHD prevention policies in Argentina should address contextual aspects linked to SES, such as access to education or healthcare, and should also aim to implement known clinical strategies to achieve better control of CHD risk factors in all socioeconomic levels.
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Affiliation(s)
- M. Victoria Salgado
- Centro de Estudios de Estado y Sociedad, Ciudad de Buenos Aires, Argentina
- Unidad de Conocimiento Traslacional Hospitalaria Patagónica, Hospital SAMIC El Calafate, El Calafate, Santa Cruz, Argentina
| | - Joanne Penko
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Alicia Fernández
- UCSF Latinx Center of Excellence, University of California San Francisco, San Francisco, California, United States of America
| | - Francine Rios-Fetchko
- UCSF Latinx Center of Excellence, University of California San Francisco, San Francisco, California, United States of America
| | - Pamela G. Coxson
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Raúl Mejia
- Centro de Estudios de Estado y Sociedad, Ciudad de Buenos Aires, Argentina
- Hospital de Clínicas, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
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Mohottige D. Paving a Path to Equity in Cardiorenal Care. Semin Nephrol 2024; 44:151519. [PMID: 38960842 DOI: 10.1016/j.semnephrol.2024.151519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Cardiorenal syndrome encompasses a dynamic interplay between cardiovascular and kidney disease, and its prevention requires careful examination of multiple predisposing underlying conditions. The unequal distribution of diabetes, heart failure, hypertension, and kidney disease requires special attention because of the influence of these conditions on cardiorenal disease. Despite growing evidence regarding the benefits of disease-modifying agents (e.g., sodium-glucose cotransporter 2 inhibitors) for cardiovascular, kidney, and metabolic (CKM) disease, significant disparities remain in access to and utilization of these essential therapeutics. Multilevel barriers impeding their use require multisector interventions that address patient, provider, and health system-tailored strategies. Burgeoning literature also describes the critical role of unequal social determinants of health, or the sociopolitical contexts in which people live and work, in cardiorenal risk factors, including heart failure, diabetes, and chronic kidney disease. This review outlines (i) inequality in the burden and treatment of hypertension, type 2 diabetes, and heart failure; (ii) disparities in the use of key disease-modifying therapies for CKM diseases; and (iii) multilevel barriers and solutions to achieve greater pharmacoequity in the use of disease-modifying therapies. In addition, this review provides summative evidence regarding the role of unequal social determinants of health in cardiorenal health disparities, further outlining potential considerations for future research and intervention. As proposed in the 2023 American Heart Association presidential advisory on CKM health, a paradigm shift will be needed to achieve cardiorenal health equity. Through a deeper understanding of CKM health and a commitment to equity in the prevention, detection, and treatment of CKM disease, we can achieve this critical goal.
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Affiliation(s)
- Dinushika Mohottige
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY; Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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Norland K, Schaid DJ, Naderian M, Na J, Kullo IJ. Joint Association of Polygenic Risk and Social Determinants of Health with Coronary Heart Disease in the United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.10.24301105. [PMID: 38260263 PMCID: PMC10802647 DOI: 10.1101/2024.01.10.24301105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background The joint effects of polygenic risk and social determinants of health (SDOH) on coronary heart disease (CHD) in the United States are unknown. Methods In 67,256 All of Us (AoU) participants with available SDOH data, we ascertained self-reported race/ethnicity and calculated a polygenic risk score for CHD (PRS CHD ). We used 90 SDOH survey questions to develop an SDOH score for CHD (SDOH CHD ). We assessed the distribution of SDOH CHD across self-reported races and US states. We tested the joint association of SDOH CHD and PRS CHD with CHD in regression models that included clinical risk factors. Results SDOH CHD was highest in self-reported black and Hispanic people. Self-reporting as black was associated with higher odds of CHD but not after adjustment for SDOH CHD . Median SDOH CHD values varied by US state and were associated with heart disease mortality. A 1-SD increase in SDOH CHD was associated with CHD (OR=1.36; 95% CI, 1.29 to 1.46) and incident CHD (HR=1.73; 95% CI, 1.27 to 2.35) in models that included PRS CHD and clinical risk factors. Among people in the top 20% of PRS CHD , CHD prevalence was 4.8% and 7.8% in the bottom and top 20% of SDOH CHD , respectively. Conclusions Increased odds of CHD in self-reported black people are likely due to higher SDOH burden. SDOH and PRS were independently associated with CHD in the US. Our findings emphasize the need to consider both PRS and SDOH for equitable disease risk assessment.
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Quezada-Pinedo HG, Ahanchi NS, Cajachagua-Torres KN, Obeso-Manrique JA, Huicho L, Gräni C, Muka T. A comprehensive analysis of cardiovascular mortality trends in Peru from 2017 to 2022: Insights from 183,386 deaths of the national death registry. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 35:100335. [PMID: 38511183 PMCID: PMC10946053 DOI: 10.1016/j.ahjo.2023.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 03/22/2024]
Abstract
Background/objectives Cardiovascular diseases are the leading cause of global mortality. Systematic studies on cardiovascular-related mortality at national and subnational levels in Peru are lacking. We aimed to describe the trends in cardiovascular-related mortality between 2017 and 2022 in Peru at national and subnational levels and by socioeconomic indicators. Subjects/methods We used data from the Peruvian death registry 2017-2022. Using ICD-10 codes, mortality was categorized into: hypertensive-, coronary-, and cerebrovascular- related deaths. We estimated age-standardized cardiovascular-related mortality rates by sex at national and regional levels, and by natural regions (Coast, Highlands, Amazon). We estimated the change in mortality rates between 2017-2019 and 2020-2022 and explored factors that contributed to such a change. We explored ecological relationships between mortality rates and socioeconomic indicators. Findings Overall 183,386 cardiovascular-related deaths were identified. Coronary-related deaths (37.2 %) were followed by hypertensive-related (25.1 %) and cerebrovascular-related deaths (22.6 %). Peru showed a marked increasing trend in cardiovascular-related mortality in 2020-2022 (77.8 %). The increase clustered in the Coast and Highlands, with the highest change observed in Lima (132.1 %). Mortality was highest in subjects with lower education and subjects with public health insurance. Gini coefficient was associated with lower mortality rates while unemployment was associated with higher mortality rates. Interpretation There was a notable rise in cardiovascular-related mortality in Peru, particularly during the Covid-19 pandemic with a slight decrease in 2022. Gaining a comprehensive understanding of the factors that contribute to the increase in cardiovascular deaths in Peru will facilitate the development of precise interventions at both the national and regional levels.
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Affiliation(s)
- Hugo G. Quezada-Pinedo
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Noushin Sadat Ahanchi
- Institute of Social and Preventive Medicine (ISPM), Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Internal Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Kim N. Cajachagua-Torres
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Pediatrics, New York University Grossman of Medicine, New York, USA
| | - Jordan A. Obeso-Manrique
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Christoph Gräni
- Institute of Social and Preventive Medicine (ISPM), Graduate School of Health Sciences, University of Bern, Bern, Switzerland
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García-Mayor J, Moreno-Llamas A, De la Cruz-Sánchez E. How socioeconomic status affects weight status through health-related lifestyles: a latent class analysis. Eur J Cardiovasc Nurs 2023; 22:730-744. [PMID: 36316287 DOI: 10.1093/eurjcn/zvac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 10/12/2023]
Abstract
AIMS Obesity levels have increased worldwide with serious public health concerns. However, weight status is related to socioeconomic status (SES), which may also influence health-related lifestyles. Here, we study the association between SES and obesity mediated by diet and physical activity. METHODS AND RESULTS Using cross-sectional data from 2006, 2011, 2014, and 2017 Spanish health surveys (the final sample consisted of 61 768 adults aged between 18 and 64 years), we conducted a latent class analysis to estimate health-related lifestyle clusters (based on dietary patterns and physical activity) and mediation analyses to evaluate the association of SES and obesity through the clustering of health-related lifestyles. In both men and women, SES was inversely related to obesity (P < 0.001) and positively related to healthier lifestyle classes (P < 0.001). Obesity was inversely related to healthier lifestyle classes (P < 0.001). A small-although significant-proportion mediated by the clustering of lifestyles was found as follows: 4.9%, 95% CI (6.6%, 3.2%) in men and 2.3%, 95% CI (3.4%, 1.3%) in women for educational attainment, 5.3%, 95% CI (7.2%, 3.6%) in men and 2.0%, 95% CI (2.9%, 1.1%) in women for occupational social class, and 4.9%, 95% CI (6.5%, 3.1%) and 1.9%, 95% CI (2.9%, 1.1%) combining the above two SES indicators. CONCLUSIONS SES is related to obesity through clustering health-related lifestyles, with greater emphasis on men. However, the complex relationship between SES and weight status also suggests other indicators that contribute to the social gradient of obesity.
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Affiliation(s)
- Jesús García-Mayor
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, C/Santa Alicia s/n, Murcia 30720, Spain
| | - Antonio Moreno-Llamas
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, C/Santa Alicia s/n, Murcia 30720, Spain
| | - Ernesto De la Cruz-Sánchez
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, C/Santa Alicia s/n, Murcia 30720, Spain
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Ma Z, Zhang Y, Zhou C, Liu D, Gu S, Zuo H. Independent and combined effect of income and education attainment on the incidence of stroke events: a large-scale cohort study from rural communities in China. Neurol Res 2023; 45:627-633. [PMID: 36745626 DOI: 10.1080/01616412.2023.2176630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Few studies have longitudinally evaluated income and education, and their combined effect on incident of stroke in China. METHODS The present study was based on a cohort with a baseline survey in China. A total of 15,913 participants were finally included. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were calculated to evaluate the association of income, education, and their combination with stroke risk by Cox proportional hazard model. RESULTS Lower income and less years of education was significantly associated with an increased risk of total stroke [income: adjusted HR: 1.54 (95% CI: 1.22-1.95); education: adjusted HR: 1.59 (95% CI: 1.11-2.28)]. Notably, the highest risk for total stroke was seen among those with lower income and higher education (adjusted HR: 2.46, 95% CI: 1.36-4.47). Sensitivity analysis by excluding the first year of follow-up showed similar findings with the primary analysis. DISCUSSION Lower income and education attainment were associated with an increased risk of stroke in Chinese countrysides. A joint effect of income and education existed on the risk of developing stroke. Special attention should be paid for rural community residents, especially for people with low income levels.
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Affiliation(s)
- Ze Ma
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Ya Zhang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Chen Zhou
- The second Affiliated Hospital of Soochow University, Suzhou, China
| | - Dong Liu
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Shujun Gu
- Department of Chronic Disease Control and Prevention, Changshu Center for Disease Control and Prevention, Changshu, China
| | - Hui Zuo
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
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10
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Dawson LP, Andrew E, Nehme Z, Bloom J, Biswas S, Cox S, Anderson D, Stephenson M, Lefkovits J, Taylor AJ, Kaye D, Smith K, Stub D. Association of Socioeconomic Status With Outcomes and Care Quality in Patients Presenting With Undifferentiated Chest Pain in the Setting of Universal Health Care Coverage. J Am Heart Assoc 2022; 11:e024923. [PMID: 35322681 PMCID: PMC9075482 DOI: 10.1161/jaha.121.024923] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study aimed to assess whether there are disparities in incidence rates, care, and outcomes for patients with chest pain attended by emergency medical services according to socioeconomic status (SES) in a universal health coverage setting. METHODS AND RESULTS This was a population‐based cohort study of individually linked ambulance, emergency, hospital admission, and mortality data in the state of Victoria, Australia, from January 2015 to June 2019 that included 183 232 consecutive emergency medical services attendances for adults with nontraumatic chest pain (mean age 62 [SD 18] years; 51% women) and excluded out‐of‐hospital cardiac arrest and ST‐segment–elevation myocardial infarction. Age‐standardized incidence of chest pain was higher for patients residing in lower SES areas (lowest SES quintile 1595 versus highest SES quintile 760 per 100 000 person‐years; P<0.001). Patients of lower SES were less likely to attend metropolitan, private, or revascularization‐capable hospitals and had greater comorbidities. In multivariable models adjusted for clinical characteristics and final diagnosis, lower SES quintiles were associated with increased risks of 30‐day and long‐term mortality, readmission for chest pain and acute coronary syndrome, lower acuity emergency department triage categorization, emergency department length of stay >4 hours, and emergency department or emergency medical services discharge without hospital admission and were inversely associated with use of prehospital ECGs and transfer to a revascularization‐capable hospital for patients presenting to non‐percutaneous coronary intervention centers. CONCLUSIONS In this study, lower SES was associated with a higher incidence of chest pain presentations to emergency medical services and differences in care and outcomes. These findings suggest that substantial disparities for socioeconomically disadvantaged chest pain cohorts exist, even in the setting of universal health care access.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Department of Cardiology The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Emily Andrew
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia
| | - Ziad Nehme
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia.,Department of Paramedicine Monash University Melbourne Victoria Australia
| | - Jason Bloom
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,The Baker Institute Melbourne Victoria Australia
| | - Sinjini Biswas
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Shelley Cox
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia
| | - David Anderson
- Ambulance Victoria Melbourne Victoria Australia.,Department of Intensive Care Medicine The Alfred Hospital Melbourne Victoria Australia
| | - Michael Stephenson
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia.,Department of Paramedicine Monash University Melbourne Victoria Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Department of Cardiology The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Andrew J Taylor
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Department of Medicine Monash University Melbourne Victoria Australia
| | - David Kaye
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,The Baker Institute Melbourne Victoria Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,Ambulance Victoria Melbourne Victoria Australia.,Department of Paramedicine Monash University Melbourne Victoria Australia
| | - Dion Stub
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia.,The Baker Institute Melbourne Victoria Australia
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11
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King JB, Pinheiro LC, Ringel JB, Bress AP, Shimbo D, Muntner P, Reynolds K, Cushman M, Howard G, Manly JJ, Safford MM. Multiple Social Vulnerabilities to Health Disparities and Hypertension and Death in the REGARDS Study. Hypertension 2022; 79:196-206. [PMID: 34784734 PMCID: PMC8665033 DOI: 10.1161/hypertensionaha.120.15196] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Social vulnerabilities increase the risk of developing hypertension and lower life expectancy, but the effect of an individual's overall vulnerability burden is unknown. Our objective was to determine the association of social vulnerability count and the risk of developing hypertension or dying over 10 years and whether these associations vary by race. We used the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) and included participants without baseline hypertension. The primary exposure was the count of social vulnerabilities defined across economic, education, health and health care, neighborhood and built environment, and social and community context domains. Among 5425 participants of mean age 64±10 SD years of which 24% were Black participants, 1468 (31%) had 1 vulnerability and 717 (15%) had ≥2 vulnerabilities. Compared with participants without vulnerabilities, the adjusted relative risk ratio for developing hypertension was 1.16 (95% CI, 0.99-1.36) and 1.49 (95% CI, 1.20-1.85) for individuals with 1 and ≥2 vulnerabilities, respectively. The adjusted relative risk ratio for death was 1.55 (95% CI, 1.24-1.93) and 2.30 (95% CI, 1.75-3.04) for individuals with 1 and ≥2 vulnerabilities, respectively. A greater proportion of Black participants developed hypertension and died than did White participants (hypertension, 38% versus 31%; death, 25% versus 20%). The vulnerability count association was strongest in White participants (P value for vulnerability count×race interaction: hypertension=0.046, death=0.015). Overall, a greater number of socially determined vulnerabilities was associated with progressively higher risk of developing hypertension, and an even higher risk of dying over 10 years.
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Affiliation(s)
- Jordan B. King
- Department of Population Health Sciences, School of Medicine, University of Utah,Institute for Health Research, Kaiser Permanente Colorado
| | | | | | - Adam P. Bress
- Department of Population Health Sciences, School of Medicine, University of Utah
| | - Daichi Shimbo
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons
| | - Paul Muntner
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California,Department of Health Systems Science, Kaiser Permanente School of Medicine
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine, University of Vermont
| | - George Howard
- Department of Biostatistics, Ryals School of Public Health, University of Alabama at Birmingham
| | - Jennifer J. Manly
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons
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12
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Gullon P, Bilal U, Hirsch JA, Rundle AG, Judd S, Safford MM, Lovasi GS. Does a physical activity supportive environment ameliorate or exacerbate socioeconomic inequities in incident coronary heart disease? J Epidemiol Community Health 2021; 75:637-642. [PMID: 33318134 PMCID: PMC8200362 DOI: 10.1136/jech-2020-215239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/30/2020] [Accepted: 11/29/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Efforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated or exacerbated in environments supportive of physical activity (PA). METHODS We used data from the Reasons for Geographic and Racial Differences in Stroke study, which recruited US residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n=20 808), followed until 31 December 2014. We categorised household income and treated it as ordinal: (1) US$75 000+, (2) US$35 000-US$74 000, (3) US$20 000-US$34 000 and (4) RESULTS We found a 25% (95% CI 1.17% to 1.34%) increased hazard of CHD per 1-category decrease in household income category. Adjusting for PA-supportive environments slightly reduced this association (HR=1.24). The income-CHD association was strongest in areas without walking destinations (HR=1.57), an interaction which reached statistical significance in analyses among men. In contrast, the income-CHD association showed a trend towards being strongest in areas with the highest percentage of green land cover. CONCLUSIONS Indicators of a PA supportive environment show divergent trends to modify socioeconomic inequities in CHD . Built environment interventions should measure the effect on socioeconomic inequities.
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Affiliation(s)
- Pedro Gullon
- Public Health and Epidemiology Research Group, Universidad de Alcala de Henares Facultad de Medicina y Ciencias de la Salud, Alcala de Henares, Spain
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Jana A Hirsch
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Andrew G Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham College of Arts and Sciences, Birmingham, Alabama, USA
| | - Monika M Safford
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, New York, USA
| | - Gina S Lovasi
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
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13
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García-Mayor J, Moreno-Llamas A, la Cruz-Sánchez ED. High educational attainment redresses the effect of occupational social class on health-related lifestyle: findings from four Spanish national health surveys. Ann Epidemiol 2021; 58:29-37. [PMID: 33640485 DOI: 10.1016/j.annepidem.2021.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/26/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Social determinants as occupational social class or educational attainment might influence health outcomes. This phenomenon is known as the social gradient of health and is related to a skewed distribution of health behaviours that might explain differences in morbidity and mortality between social groups. But social class and educational attainment differ in their nature and might have distinct effects on health. Here we study the combined effect of educational attainment and occupational social class on health-related lifestyle. METHODS We retrieved data from four large-scale, national representative Spanish surveys (n = 67,171). A latent class regression analysis was run to identify clusters of health-related lifestyle behaviours. Clusters were made according to sociodemographic factors, including a combined analysis of education and occupational social class. RESULTS Higher educational attainment and occupational social class were associated with a healthier lifestyle for both sexes. The combined analysis of education and social class indicated that women with secondary education showed a high risk combination of unhealthy behaviours, as men with middle, primary or no education. CONCLUSIONS Regardless of social class, a higher educational attainment redresses the effect of occupational social class on health-related behaviours. Our results suggest that education likely plays a crucial role in population health outcomes through its effects on lifestyle.
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14
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Hassen HY, Bastiaens H, Van Royen K, Abrams S. Socioeconomic and behavioral determinants of cardiovascular diseases among older adults in Belgium and France: A longitudinal analysis from the SHARE study. PLoS One 2020; 15:e0243422. [PMID: 33275617 PMCID: PMC7717541 DOI: 10.1371/journal.pone.0243422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/21/2020] [Indexed: 11/19/2022] Open
Abstract
Despite advances in the healthcare system, cardiovascular diseases (CVDs) are still an important public health problem with disparities in the burden within and between countries. Studies among the adult population documented that socioeconomic and environmental factors play a role in the incidence and progression of CVDs. However, evidence is scarce on the socioeconomic determinants and the interplay with behavioral risks among older adults. Therefore, we identified socioeconomic and behavioral determinants of CVDs among older adults. Our sample consisted of 14,322 people aged 50 years and above from Belgium and France who responded to the waves 4, 5, 6 and/or 7 of the Survey of Health Ageing and Retirement in Europe. The effect of determinants on the occurrence of CVD was examined using a Generalized Estimating Equation (GEE) approach for binary longitudinal data. The overall rate of heart attack was 8.3%, which is 7.6% in Belgium and 9.1% in France. Whereas, 2.6% and 2.3% in Belgium and France, respectively, had experienced stroke. In the multivariable GEE model, older age [AOR: 1.057, 95%CI: 1.055-1.060], living in large cities [AOR: 1.14, 95%CI: 1.07-1.18], and retirement [AOR: 1.21, 95%CI: 1.16-1.31] were associated with higher risk of CVD. Furthermore, higher level of education [AOR: 0.82, 95%CI: 0.79-0.90], upper wealth quantile [AOR: 0.82, 95%CI: 0.76-0.86] and having social support [AOR: 0.81, 95%CI: 0.77-0.84] significantly lowers the odds of having CVD. A higher hand grip strength was also significantly associated with lower risk of CVD [AOR: 0.987, 95%CI: 0.984-0.990]. This study demonstrated that older adults who do not have social support, live in big cities, belong to the lowest wealth quantile, and have a low level of education have a higher likelihood of CVD. Therefore, community-based interventions aimed at reducing cardiovascular risks need to give more emphasis to high-risk retired older adults with lower education, no social support and those who live in large cities.
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Affiliation(s)
- Hamid Yimam Hassen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kathleen Van Royen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Communication Studies, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Steven Abrams
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Diepenbeek, Belgium
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15
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Safford MM, Reshetnyak E, Sterling MR, Richman JS, Muntner PM, Durant RW, Booth J, Pinheiro LC. Number of Social Determinants of Health and Fatal and Nonfatal Incident Coronary Heart Disease in the REGARDS Study. Circulation 2020; 143:244-253. [PMID: 33269599 PMCID: PMC7856168 DOI: 10.1161/circulationaha.120.048026] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Social determinants of health (SDH) are individually associated with incident coronary heart disease (CHD) events. Indices reflecting social deprivation have been developed for population management, but are difficult to operationalize during clinical care. We examined whether a simple count of SDH is associated with fatal incident CHD and nonfatal myocardial infarction (MI). METHODS We used data from the prospective longitudinal REGARDS cohort study (Reasons for Geographic and Racial Differences in Stroke), a national population-based sample of community-dwelling Black and White adults age ≥45 years recruited from 2003 to 2007. Seven SDH from the 5 Healthy People 2020 domains included social context (Black race, social isolation); education (educational attainment); economic stability (annual household income); neighborhood (living in a zip code with high poverty); and health care (lacking health insurance, living in 1 of the 9 US states with the least public health infrastructure). Outcomes were expert adjudicated fatal incident CHD and nonfatal MI. RESULTS Of 22 152 participants free of CHD at baseline, 58.8% were women and 42.0% were Black; 20.6% had no SDH, 30.6% had 1, 23.0% had 2, and 25.8% had ≥3. There were 463 fatal incident CHD events and 932 nonfatal MIs over a median of 10.7 years (interquartile range, 6.6 to 12.7). Fewer SDHs were associated with nonfatal MI than with fatal incident CHD. The age-adjusted incidence per 1000 person-years increased with the number of SDH for both fatal incident CHD (0 SDH, 1.30; 1 SDH, 1.44; 2 SDH, 2.05; ≥3 SDH, 2.86) and nonfatal MI (0 SDH, 3.91; 1 SDH, 4.33; ≥2 SDH, 5.44). Compared with those without SDH, crude and fully adjusted hazard ratios for fatal incident CHD among those with ≥3 SDH were 3.00 (95% CI, 2.17 to 4.15) and 1.67 (95% CI, 1.18 to 2.37), respectively; hazard ratios for nonfatal MI among those with ≥2 SDH were 1.57 (95% CI, 1.30 to 1.90) and 1.14 (95% CI, 0.93 to 1.41), respectively. CONCLUSIONS A greater burden of SDH was associated with a graded increase in risk of incident CHD, with greater magnitude and independent associations for fatal incident CHD. Counting the number of SDHs may be a promising approach that could be incorporated into clinical care to identify individuals at high risk of CHD.
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Affiliation(s)
- Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York (M.M.S., E.R., M.R.S., L.C.P.)
| | - Evgeniya Reshetnyak
- Department of Medicine, Weill Cornell Medicine, New York (M.M.S., E.R., M.R.S., L.C.P.)
| | - Madeline R Sterling
- Department of Medicine, Weill Cornell Medicine, New York (M.M.S., E.R., M.R.S., L.C.P.)
| | - Joshua S Richman
- Department of Surgery (J.S.R.), University of Alabama at Birmingham Medical School
| | - Paul M Muntner
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health (P.M.M., J.B.)
| | - Raegan W Durant
- Department of Medicine (R.W.D.), University of Alabama at Birmingham Medical School
| | - John Booth
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health (P.M.M., J.B.)
| | - Laura C Pinheiro
- Department of Medicine, Weill Cornell Medicine, New York (M.M.S., E.R., M.R.S., L.C.P.)
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16
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Abstract
IMPORTANCE Income disparity between persons with the most resources (the top 20% of earners) and the remainder of the population in the United States has dramatically widened over the past few decades. Given the well-established association between income and health, this increasing income gap may provide insights into the dynamics of cardiovascular disease (CVD) burden among adults in the US. OBJECTIVE To quantify the contribution of people in the highest-resources group and the remainder of the population to the burden of CVD, and to estimate the trends in the prevalence of CVD for the 2 groups in the United States from 1999 to 2016. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional analysis used nationally representative data from 9 cycles of the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016. Survey participants were adults 20 years or older. Statistical analysis of the data was conducted in December 2019. MAIN OUTCOMES AND MEASURES Age-standardized prevalence of CVD was calculated using the 2010 census estimates. Participants were stratified by income group using the NHANES income to poverty ratio, which was converted into a binary variable: a ratio of 5 or greater for the highest-resources group and a ratio of less than 5 for the remainder of the population. RESULTS This analysis included 44 986 participants. Among the 7926 participants in the highest-resources group, 3290 (50.3%) were in the 40- to 59-year age group and 4094 (51.9%) were men. Among the 37 060 participants in the remainder of the population, 10 840 (34.1%) were in the 40- to 59-year age group and 19 470 (53.2%) were women. The age-standardized prevalence of CVD decreased in the highest-resources group during the study period (1999-2016): angina from 3.4% (n = 24) to 0.3% (n = 5), heart attack from 3.2% (n = 24) to 1.4% (n = 19), congestive heart failure (CHF) from 1.2% (n = 11) to 0.5% (n = 7), and stroke from 1.1% to 1.0% (n = 8). In the remainder of the population, the prevalence of angina decreased from 3.3% (n = 131) in 1999 to 2.6% (n = 118) in 2016 and heart attack from 4.0% (n = 160) in 1999 to 3.6% (n = 201) in 2016. Conversely, an increase was observed in the prevalence of CHF from 2.6% (n = 123) in 1999 to 2.8% (n = 176) in 2016 and stroke from 2.9% (n = 152) in 1999 to 3.2% (n = 178) in 2016. Over time, the odds of reporting angina (odds ratio [OR], 0.80; 95% CI, 0.73-0.87; P < .001), heart attack (OR, 0.91; 95% CI, 0.86-0.97; P = .003), and CHF (OR, 0.90; 95% CI, 0.82-0.99; P = .03) decreased among those in the highest-resources group, while there was no significant change in the odds of reporting stroke (OR, 0.97; 95% CI, 0.90-1.05; P = .43). Among the remainder of the population, the odds of reporting angina (OR, 0.95; 95% CI, 0.92-0.99; P < .05) and heart attack (OR, 0.99; 95% CI, 0.97-1.02; P = .06) decreased over time. Conversely, there was no statistically significant change in the odds of reporting CHF (OR, 1.02; 95% CI, 1.00-1.05; P = .08) and stroke (OR, 1.02; 95% CI, 0.99-1.04; P = .21). CONCLUSIONS AND RELEVANCE This study found substantial and increasing disparities in CVD prevalence between the richest and poorest participants in the NHANES from 1999 to 2016, with lower CVD rate reported among the highest-resources group. Additional research into the dynamics of income inequality and health outcomes as well as policy and public health efforts to mitigate this inequality are needed.
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Affiliation(s)
- Salma M. Abdalla
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Shui Yu
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Sandro Galea
- Boston University School of Public Health, Boston, Massachusetts
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17
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Hamad R, Penko J, Kazi DS, Coxson P, Guzman D, Wei PC, Mason A, Wang EA, Goldman L, Fiscella K, Bibbins-Domingo K. Association of Low Socioeconomic Status With Premature Coronary Heart Disease in US Adults. JAMA Cardiol 2020; 5:899-908. [PMID: 32459344 DOI: 10.1001/jamacardio.2020.1458] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Individuals with low socioeconomic status (SES) bear a disproportionate share of the coronary heart disease (CHD) burden, and CHD remains the leading cause of mortality in low-income US counties. Objective To estimate the excess CHD burden among individuals in the United States with low SES and the proportions attributable to traditional risk factors and to other factors associated with low SES. Design, Setting, and Participants This computer simulation study used the Cardiovascular Disease Policy Model, a model of CHD and stroke incidence, prevalence, and mortality among adults in the United States, to project the excess burden of early CHD. The proportion of this excess burden attributable to traditional CHD risk factors (smoking, high blood pressure, high low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol, type 2 diabetes, and high body mass index) compared with the proportion attributable to other risk factors associated with low SES was estimated. Model inputs were derived from nationally representative US data and cohort studies of incident CHD. All US adults aged 35 to 64 years, stratified by SES, were included in the simulations. Exposures Low SES was defined as income below 150% of the federal poverty level or educational level less than a high school diploma. Main Outcomes and Measures Premature (before age 65 years) myocardial infarction (MI) rates and CHD deaths. Results Approximately 31.2 million US adults aged 35 to 64 years had low SES, of whom approximately 16 million (51.3%) were women. Compared with individuals with higher SES, both men and women in the low-SES group had double the rate of MIs (men: 34.8 [95% uncertainty interval (UI), 31.0-38.8] vs 17.6 [95% UI, 16.0-18.6]; women: 15.1 [95% UI, 13.4-16.9] vs 6.8 [95% UI, 6.3-7.4]) and CHD deaths (men: 14.3 [95% UI, 13.0-15.7] vs 7.6 [95% UI, 7.3-7.9]; women: 5.6 [95% UI, 5.0-6.2] vs 2.5 [95% UI, 2.3-2.6]) per 10 000 person-years. A higher burden of traditional CHD risk factors in adults with low SES explained 40% of these excess events; the remaining 60% of these events were attributable to other factors associated with low SES. Among a simulated cohort of 1.3 million adults with low SES who were 35 years old in 2015, the model projected that 250 000 individuals (19%) will develop CHD by age 65 years, with 119 000 (48%) of these CHD cases occurring in excess of those expected for individuals with higher SES. Conclusions and Relevance This study suggested that, for approximately one-quarter of US adults aged 35 to 64 years, low SES was substantially associated with early CHD burden. Although biomedical interventions to modify traditional risk factors may decrease the disease burden, disparities by SES may remain without addressing SES itself.
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Affiliation(s)
- Rita Hamad
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco
| | - Joanne Penko
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Pamela Coxson
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - David Guzman
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco.,Department of Medicine, University of San Francisco, San Francisco, California
| | - Pengxiao C Wei
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Antoinette Mason
- Sutter Santa Rosa Family Medicine Residency, University of California, San Francisco, Santa Rosa
| | - Emily A Wang
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lee Goldman
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
| | - Kirsten Bibbins-Domingo
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco.,Department of Medicine, University of San Francisco, San Francisco, California
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18
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Patel N, Ahmad MI, Zhang W, Soliman EZ. Interrelations of Cumulative Social Risk, Silent Myocardial Infarction, and Mortality in the General Population. Am J Cardiol 2020; 125:1823-1828. [PMID: 32327189 DOI: 10.1016/j.amjcard.2020.03.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 11/26/2022]
Abstract
Cumulative social risk (CSR), defined as experiencing more than one social risk factor, is associated with a significant increase in cardiovascular mortality. However, it is unclear whether CSR is associated with prevalent silent myocardial infarction (SMI), and whether their joint presence is predictive of mortality more than the presence of CSR in isolation. This analysis included 6,708 participants from the third National Health and Nutrition Examination Survey who were free of clinical cardiovascular disease at the time of enrollment. Baseline social risk factors (poverty-income ratio <1, minority race, education <12 grade, and living single) were used to create the CSR score with values ranging from 0 to ≥3. SMI was defined as electrocardiographic evidence of MI in the absence of clinical MI. In a multivariable-adjusted logistic regression model, baseline CSR ≥ 3 (vs 0) was associated with a higher prevalence of SMI (odds ratio [95% confidence interval]: 2.21 [1.16 to 4.23]). Over a median follow-up of 14 years, there were 2,151 all-cause deaths. Compared with CSR of 0 and no SMI, the risk of mortality with CSR was higher in the presence of SMI than without SMI (multivariable adjusted Hazard Ratios [95% confidence intervals] with vs without SMI were 1.76 [1.13 to 2.75] vs 1.27 [1.10 to 1.46] for CSR≥ 3; 2.06 [1.31 to 3.24] vs 1.21 [1.06 to 1.39] for CSR = 2; and 2.02 [1.31 to 3.12] vs 1.33 [0.63 to 2.82] for CSR = 1, respectively). In conclusion, exposure to CSR is associated with increased risk of SMI, and concomitant presence of SMI with CSR is associated with a higher risk of mortality than presence of CSR alone.
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19
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4939] [Impact Index Per Article: 1234.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5401] [Impact Index Per Article: 1080.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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21
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Kelli HM, Mehta A, Tahhan AS, Liu C, Kim JH, Dong TA, Dhindsa DS, Ghazzal B, Choudhary MK, Sandesara PB, Hayek SS, Topel ML, Alkhoder AA, Martini MA, Sidoti A, Ko Y, Lewis TT, Vaccarino V, Sperling LS, Quyyumi AA. Low Educational Attainment is a Predictor of Adverse Outcomes in Patients With Coronary Artery Disease. J Am Heart Assoc 2019; 8:e013165. [PMID: 31476920 PMCID: PMC6755831 DOI: 10.1161/jaha.119.013165] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/15/2019] [Indexed: 01/03/2023]
Abstract
Background Educational attainment is an indicator of socioeconomic status and is inversely associated with coronary artery disease risk. Whether educational attainment level (EAL) among patients with coronary artery disease influences outcomes remains understudied. Methods and Results Patients undergoing cardiac catheterization had their highest EAL assessed using options of elementary/middle school, high school, college, or graduate education. Primary outcome was all-cause mortality and secondary outcomes were a composite of cardiovascular death/non-fatal myocardial infarction and non-fatal myocardial infarction during follow-up. Cox models adjusted for clinically relevant confounders were used to analyze the association of EAL with outcomes. Among 6318 patients (63.5 years, 63% men, 23% black) enrolled, 16%, 42%, 38%, and 4% had received graduate or higher, college, high school, and elementary/middle school education, respectively. During 4.2 median years of follow-up, there were 1066 all-cause deaths, 812 cardiovascular deaths/non-fatal myocardial infarction, and 276 non-fatal myocardial infarction. Compared with patients with graduate education, those in lower EAL categories (elementary/middle school, high school, or college education) had a higher risk of all-cause mortality (hazard ratios 1.52 [95% CI 1.11-2.09]; 1.43 [95% CI 1.17-1.73]; and 95% CI 1.26 [1.03-1.53], respectively). Similar findings were observed for secondary outcomes. Conclusions Low educational attainment is an independent predictor of adverse outcomes in patients undergoing angiographic coronary artery disease evaluation. The utility of incorporating EAL into risk assessment algorithms and the causal link between low EAL and adverse outcomes in this high-risk patient population need further investigation.
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Affiliation(s)
- Heval M. Kelli
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Anurag Mehta
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Ayman S. Tahhan
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Chang Liu
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGA
| | - Jeong Hwan Kim
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Tiffany A. Dong
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
- Department of MedicineEmory University School of MedicineAtlantaGA
| | - Devinder S. Dhindsa
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Bahjat Ghazzal
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Muaaz K. Choudhary
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Pratik B. Sandesara
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Salim S. Hayek
- Division of CardiologyDepartment of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMI
| | - Matthew L. Topel
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Ayman A. Alkhoder
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Mohamed A. Martini
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Arianna Sidoti
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Yi‐An Ko
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGA
| | - Tene T. Lewis
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGA
| | - Viola Vaccarino
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Laurence S. Sperling
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Arshed A. Quyyumi
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
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22
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Zhao X, Geng X, Srinivasasainagendra V, Chaudhary N, Judd S, Wadley V, Gutiérrez OM, Wang H, Lange EM, Lange LA, Woo D, Unverzagt FW, Safford M, Cushman M, Limdi N, Quarells R, Arnett DK, Irvin MR, Zhi D. A PheWAS study of a large observational epidemiological cohort of African Americans from the REGARDS study. BMC Med Genomics 2019; 12:26. [PMID: 30704471 PMCID: PMC6357353 DOI: 10.1186/s12920-018-0462-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cardiovascular disease, diabetes, and kidney disease are among the leading causes of death and disability worldwide. However, knowledge of genetic determinants of those diseases in African Americans remains limited. RESULTS In our study, associations between 4956 GWAS catalog reported SNPs and 67 traits were examined among 7726 African Americans from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, which is focused on identifying factors that increase stroke risk. The prevalent and incident phenotypes studied included inflammation, kidney traits, cardiovascular traits and cognition. Our results validated 29 known associations, of which eight associations were reported for the first time in African Americans. CONCLUSION Our cross-racial validation of GWAS findings provide additional evidence for the important roles of these loci in the disease process and may help identify genes especially important for future functional validation.
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Affiliation(s)
- Xueyan Zhao
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Xin Geng
- BGI-Shenzhen, Shenzhen, 518083 China
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030 USA
| | | | - Ninad Chaudhary
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Virginia Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Orlando M. Gutiérrez
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233 USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Henry Wang
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Ethan M. Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Leslie A. Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267 USA
| | - Frederick W. Unverzagt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Monika Safford
- Division of General Internal Medicine, Weill Cornell Medical College, Cornell University, New York, NY 10065 USA
| | - Mary Cushman
- Department of Medicine and Pathology, Larner College of Medicine at the University of Vermont, Burlington, VT 05405 USA
| | - Nita Limdi
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Rakale Quarells
- Cardiovascular Research Institute, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310 USA
| | - Donna K. Arnett
- College of Public Health, University of Kentucky, Lexington, KY 40506 USA
| | - Marguerite R. Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Degui Zhi
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030 USA
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030 USA
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23
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Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P, Quyyumi AA, Taylor HA, Gulati M, Harold JG, Mieres JH, Ferdinand KC, Mensah GA, Sperling LS. Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions. Circulation 2018; 137:2166-2178. [PMID: 29760227 PMCID: PMC5958918 DOI: 10.1161/circulationaha.117.029652] [Citation(s) in RCA: 755] [Impact Index Per Article: 125.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment.
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Affiliation(s)
| | - Heval M Kelli
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | | | | | - Jia Shen
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | - Pratik Sandesara
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | | | - Martha Gulati
- University of Arizona-Phoenix College of Medicine (M.G.)
| | - John G Harold
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (J.G.H.)
| | | | | | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.)
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
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24
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4550] [Impact Index Per Article: 758.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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Sumner JA, Khodneva Y, Muntner P, Redmond N, Lewis MW, Davidson KW, Edmondson D, Richman J, Safford MM. Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Low- and High-Income Participants: Findings From the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study. J Am Heart Assoc 2016; 5:JAHA.116.003930. [PMID: 27792645 PMCID: PMC5121497 DOI: 10.1161/jaha.116.003930] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Psychosocial risk for cardiovascular disease (CVD) may be especially deleterious in persons with low socioeconomic status. Most work has focused on psychosocial factors individually, but emerging research suggests that the confluence of psychosocial risk may be particularly harmful. Using data from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study, we examined associations among depressive symptoms and stress, alone and in combination, and incident CVD and all‐cause mortality as a function of socioeconomic status. Methods and Results At baseline, 22 658 participants without a history of CVD (58.8% female, 41.7% black, mean age 63.9±9.3 years) reported on depressive symptoms, stress, annual household income, and education. Participants were classified into 1 of 3 psychosocial risk groups at baseline: (1) neither depressive symptoms nor stress, (2) either depressive symptoms or stress, or (3) both depressive symptoms and stress. Cox proportional hazards models were used to predict physician‐adjudicated incident total CVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) and all‐cause mortality over a median of 7.0 years (interquartile range 5.4–8.3 years) of follow‐up. In fully adjusted models, participants with both depressive symptoms and stress had the greatest elevation in risk of developing total CVD (hazard ratio 1.48, 95% CI 1.21–1.81) and all‐cause mortality (hazard ratio 1.33, 95% CI 1.13–1.56) but only for those with low income (<$35 000) and not high (≥$35 000) income. This pattern of results was not observed in models stratified by education. Conclusions Findings suggest that screening for a combination of elevated depressive symptoms and stress in low‐income persons may help identify those at increased risk of incident CVD and mortality.
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Affiliation(s)
- Jennifer A Sumner
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yulia Khodneva
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, AL
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL
| | - Nicole Redmond
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, AL
| | - Marquita W Lewis
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, AL
| | - Karina W Davidson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Joshua Richman
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, AL
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, New York, NY
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