Socioeconomic factors and the onset of peripheral artery disease in older adults

Abstract

Summary: Background: As evidence concerning the impact of socioeconomic factors on the risk of peripheral artery disease (PAD) is sparse, we assessed the association of education and area-level factors (population density, type of municipality and local unemployment rate) on the onset of PAD in older adults. Patients and methods: The analysis used data of the getABI study, a prospective cohort study with seven years of follow-up. Onset of PAD was determined by ankle brachial index (<0.9) or PAD symptoms. Cox regression analysis was employed. Results: Out of 5,444 primary care attendees without PAD at baseline, there were 1,381 participants with PAD onset (cumulative observation time 31,739 years), yielding an event rate of 43.5 (0.95 confidence interval [0.95 CI] 41.2–45.8) per 1,000 person-years. Multivariable Cox regression analysis showed an association of PAD onset with low education (hazard ratio 1.29; 0.95 CI 1.14–1.46; P<0.001), high population density (0.93; 0.89–0.98; P=0.002), small cities (compared to large cities) (0.71; 0.53–0.96; P=0.027) and high local unemployment rate (1.04; 1.00–1.07; P=0.032). The impact of low education on PAD onset was higher for men (2.11; 1.64–2.72) than for women (1.22; 1.07–1.40) (interaction term P=0.013). Conclusions: Socioeconomic factors, education as well as area-level socioeconomic indicators, make independent contributions to PAD onset in older adults.