TY - JOUR
T1 - Socioeconomic status and incidence of hospitalization with lower-extremity peripheral artery disease
T2 - Atherosclerosis risk in communities study
AU - Vart, Priya
AU - Coresh, Josef
AU - Kwak, Lucia
AU - Ballew, Shoshana H.
AU - Heiss, Gerardo
AU - Matsushita, Kunihiro
N1 - Funding Information:
Matsushita received a grant and personal fee from Fukuda Denshi, unrelated to this work. Other authors declare no conflict of interest.
Funding Information:
The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268-201100008C, HHSN268201100009C, HHSN2682011000-10C, HHSN268201100011C, and HHSN268201100012C). Matsushita was supported by a grant from the National Heart, Lung, And Blood Institute (R21HL133694). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
Publisher Copyright:
© 2017 The Authors and Medtronic.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Background--Compared to coronary heart disease, heart failure, and stroke, the relationship between low socioeconomic status (SES) and peripheral artery disease (PAD) is less well established. We examined the association between SES and incidence of hospitalization with PAD and explored whether this association can be explained by traditional cardiovascular risk factors and healthcare access. Methods and Results--A total of 12 517 participants in the Atherosclerosis Risk in Communities (ARIC) Study (1987-1989) with no prior PAD were examined. Individual-level SES was assessed from household income (low < $12 000/year, medium $12 000 to $24 999/year, and high ≥$25 000/year [double to approximate to values in 2016]) and educational attainment (< high school, high school, and > high school), and area-level SES from area deprivation index (quintiles). During a median follow-up of 23.6 (Interquartile range 19.6-24.5) years, 433 participants had a hospitalization with PAD. In Cox proportional hazards regression analysis, the demographically adjusted hazard ratio was 2.42 (1.81-3.23) for low household income, 2.08 (1.60-2.69) for low educational attainment, and 2.18 (1.35-3.53) for most deprived neighborhoods, compared to their high-SES counterparts. After adjustment for traditional cardiovascular risk factors and heath care access, the associations were attenuated but remained significant, particularly for income and education. Results were consistent when stratified by race (P-values for interaction > 0.2 for all SES parameters). Conclusions--Low individual- and area-level SES are strong predictors of hospitalization with PAD, in part due to increased prevalence of cardiovascular risk factors and poor access to care in these groups. Additional risk factors may also need to be identified and acted on to eliminate SES disparities in PAD hospitalization.
AB - Background--Compared to coronary heart disease, heart failure, and stroke, the relationship between low socioeconomic status (SES) and peripheral artery disease (PAD) is less well established. We examined the association between SES and incidence of hospitalization with PAD and explored whether this association can be explained by traditional cardiovascular risk factors and healthcare access. Methods and Results--A total of 12 517 participants in the Atherosclerosis Risk in Communities (ARIC) Study (1987-1989) with no prior PAD were examined. Individual-level SES was assessed from household income (low < $12 000/year, medium $12 000 to $24 999/year, and high ≥$25 000/year [double to approximate to values in 2016]) and educational attainment (< high school, high school, and > high school), and area-level SES from area deprivation index (quintiles). During a median follow-up of 23.6 (Interquartile range 19.6-24.5) years, 433 participants had a hospitalization with PAD. In Cox proportional hazards regression analysis, the demographically adjusted hazard ratio was 2.42 (1.81-3.23) for low household income, 2.08 (1.60-2.69) for low educational attainment, and 2.18 (1.35-3.53) for most deprived neighborhoods, compared to their high-SES counterparts. After adjustment for traditional cardiovascular risk factors and heath care access, the associations were attenuated but remained significant, particularly for income and education. Results were consistent when stratified by race (P-values for interaction > 0.2 for all SES parameters). Conclusions--Low individual- and area-level SES are strong predictors of hospitalization with PAD, in part due to increased prevalence of cardiovascular risk factors and poor access to care in these groups. Additional risk factors may also need to be identified and acted on to eliminate SES disparities in PAD hospitalization.
KW - Epidemiology
KW - Peripheral artery disease
KW - Socioeconomic position
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U2 - 10.1161/JAHA.116.004995
DO - 10.1161/JAHA.116.004995
M3 - Article
C2 - 28862929
AN - SCOPUS:85030674308
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 8
M1 - e004995
ER -