Affiliation:
1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
2. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
Abstract
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
72 articles.
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