Income disparity and incident cardiovascular disease in older Americans,Progress in Cardiovascular Diseases

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Income disparity and incident cardiovascular disease in older Americans
Progress in Cardiovascular Diseases ( IF 5.6 ) Pub Date : 2021-07-25 , DOI: 10.1016/j.pcad.2021.07.010
Charles Faselis ₁ , Lowell Safren ₂ , Richard M Allman ₃ , Phillip H Lam ₄ , Vijaywant Brar ₄ , Charity J Morgan ₅ , Amiya A Ahmed ₆ , Prakash Deedwania ₇ , Kannayiram Alagiakrishnan ₈ , Farooq H Sheikh ₉ , Gregg C Fonarow ₁₀ , Ali Ahmed ₁₁

Affiliation

Veterans Affairs Medical Center, Washington, DC, U.S.A.; George Washington University, Washington, DC, U.S.A.; Uniformed Services University, Washington, DC, U.S.A..
Veterans Affairs Medical Center, Washington, DC, U.S.A.; Georgetown University, Washington, DC, U.S.A.; MedStar Washington Hospital Center, Washington, DC, U.S.A.; Cooper Medical School of Rowan University, Camden, NJ, U.S.A.
George Washington University, Washington, DC, U.S.A.; University of Alabama at Birmingham, Birmingham, AL, U.S.A.
Veterans Affairs Medical Center, Washington, DC, U.S.A.; Georgetown University, Washington, DC, U.S.A.; MedStar Washington Hospital Center, Washington, DC, U.S.A.
Veterans Affairs Medical Center, Washington, DC, U.S.A.; University of Alabama at Birmingham, Birmingham, AL, U.S.A.
University of Maryland, Baltimore, MD, U.S.A.
Veterans Affairs Medical Center, Washington, DC, U.S.A.; University of California, San Francisco, CA, U.S.A.
University of Alberta, Edmonton, Alberta, Canada.
Georgetown University, Washington, DC, U.S.A.; MedStar Washington Hospital Center, Washington, DC, U.S.A.
University of California, Los Angeles, CA, U.S.A.
Veterans Affairs Medical Center, Washington, DC, U.S.A.; George Washington University, Washington, DC, U.S.A.; Georgetown University, Washington, DC, U.S.A..

Objective

To examine the association between income and cardiovascular disease (CVD) in community-dwelling older adults.

Methods

Of the 5795 Medicare-eligible community-dwelling older Americans aged 65–100 years in the Cardiovascular Health Study (CHS), 4518 (78%) were free of baseline CVD, defined as heart failure, acute myocardial infarction, stroke, or peripheral arterial disease. Of them, 1846 (41%) had lower income, defined as a total annual household income <$16,000. Using propensity scores for lower income, estimated for each of the 4518 participants, we assembled a matched cohort of 1078 pairs balanced on 42 baseline characteristics. Outcomes included centrally adjudicated incident CVD and mortality.

Results

Matched participants (n = 2156) had a mean age of 73 years, 63% were women, and 13% African American. During an overall follow-up of 23 years, incident CVD, all-cause mortality and the combined endpoint of incident CVD or mortality occurred in 1094 (51%), 1726 (80%) and 1867 (87%) individuals, respectively. Compared with the higher income group, hazard ratio (HR) for time to the first occurrence of incident CVD in the lower income group was 1.16 with a 95% confidence interval (CI) of 1.03 to 1.31. A lower income was also associated with a significantly higher risk of all-cause mortality (HR, 1.19; 95% CI, 1.08–1.30), and consequently a higher risk of the combined endpoint of incident CVD or death (HR, 1.20; 95% CI, 1.09–1.31).

Conclusion

Among community-dwelling older Americans free of baseline CVD, an annual household income <$16,000 is independently associated with significantly higher risks of new-onset CVD and death.

中文翻译：

美国老年人的收入差距和心血管疾病事件

客观的

研究社区老年人的收入与心血管疾病 (CVD) 之间的关系。

方法

在心血管健康研究 (CHS) 中 5795 名 65-100 岁的符合医疗保险资格的社区居住老年美国人中，4518 名 (78%) 没有基线 CVD，定义为心力衰竭、急性心肌梗死、中风或外周动脉疾病。其中，1846 人（41%）的收入较低，定义为家庭年总收入<16,000 美元。使用对 4518 名参与者中的每一个估计的低收入倾向得分，我们组装了一个匹配的队列，由 1078 对在 42 个基线特征上平衡。结果包括集中判定的心血管事件和死亡率。

结果

匹配的参与者 ( n = 2156) 的平均年龄为 73 岁，63% 为女性，13% 为非裔美国人。在 23 年的总体随访中，分别有 1094 人（51%）、1726 人（80%）和 1867 人（87%）发生了 CVD 事件、全因死亡率和 CVD 事件或死亡率的综合终点。与高收入组相比，低收入组首次发生 CVD 的时间风险比 (HR) 为 1.16，95% 置信区间 (CI) 为 1.03 至 1.31。较低的收入还与显着较高的全因死亡风险相关（HR，1.19；95% CI，1.08-1.30），因此发生 CVD 或死亡的综合终点风险较高（HR，1.20；95 % CI，1.09–1.31）。