Income disparity and incident cardiovascular disease in older Americans

Charles Faselis; Lowell Safren; Richard M Allman; Phillip H Lam; Vijaywant Brar; Charity J Morgan; Amiya A Ahmed; Prakash Deedwania; Kannayiram Alagiakrishnan; Farooq H Sheikh; Gregg C Fonarow; Ali Ahmed

doi:10.1016/j.pcad.2021.07.010

Income disparity and incident cardiovascular disease in older Americans

Prog Cardiovasc Dis. 2022 Mar-Apr:71:92-99. doi: 10.1016/j.pcad.2021.07.010. Epub 2021 Jul 25.

Authors

Affiliations

¹ 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.. Electronic address: charles.faselis@va.gov.
² 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.
³ George Washington University, Washington, DC, U.S.A.; University of Alabama at Birmingham, Birmingham, AL, U.S.A.
⁴ 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.
⁵ Veterans Affairs Medical Center, Washington, DC, U.S.A.; University of Alabama at Birmingham, Birmingham, AL, U.S.A.
⁶ University of Maryland, Baltimore, MD, U.S.A.
⁷ Veterans Affairs Medical Center, Washington, DC, U.S.A.; University of California, San Francisco, CA, U.S.A.
⁸ University of Alberta, Edmonton, Alberta, Canada.
⁹ Georgetown University, Washington, DC, U.S.A.; MedStar Washington Hospital Center, Washington, DC, U.S.A.
¹⁰ University of California, Los Angeles, CA, U.S.A.
¹¹ Veterans Affairs Medical Center, Washington, DC, U.S.A.; George Washington University, Washington, DC, U.S.A.; Georgetown University, Washington, DC, U.S.A.. Electronic address: ali.ahmed@va.gov.

PMID: 34320387
DOI: 10.1016/j.pcad.2021.07.010

Abstract

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.

Keywords: Cardiovascular disease; Income; Older Americans.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Aged
Cardiovascular Diseases* / diagnosis
Cardiovascular Diseases* / epidemiology
Cohort Studies
Female
Heart Failure* / epidemiology
Humans
Incidence
Male
Medicare
Risk Factors
United States / epidemiology

Abstract

Publication types

MeSH terms

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