Income and recurrent events after a coronary event in women

Abstract

Strong evidence supports the existence of a social gradient in poor prognosis in patients with coronary heart disease (CHD). However, knowledge regarding what factors may explain this relationship is limited. We aimed to analyze in women CHD patients the association between personal income and recurrent events and to determine whether lifestyle, biological and psychosocial factors contribute to the explanation of this relationship. Altogether 188 women hospitalized for a cardiac event were assessed for personal income, demographic factors, lipids, inflammatory markers, cortisol, creatinine, lifestyle and psychosocial factors, i.e. alcohol consumption, smoking habits, body-mass index, depressive symptoms, anxiety, vital exhaustion, availability of social interaction, hostility and anger-related characteristics and were followed for cardiovascular death and recurrent acute myocardial infarction (AMI). During the 6-year follow-up 18 patients deceased and 31 experienced cardiovascular death or nonfatal AMI. After adjustment for confounders, patients with medium and high income had lower risk for recurrent events relative to those with low income (HR (95% CI): 0.38 (0.15-0.97) and 0.39 (0.17-0.93), respectively). Controlling for smoking reduced by 12.8% the risk for recurrent events associated with high versus low income, while adjusting for depression decreased the risk for middle versus low income by 13.5%. Anger symptoms explained 16.7% of the risk for recurrent events associated with middle versus low income and 10.2% of the risk for high versus low income. We suggest that in women with CHD low income is associated with recurrent events and that smoking, depressive symptomatology and anger symptoms may contribute to the explanation of this relationship.

Socioeconomic inequalities in health-related quality of life between men and women, 5 years after a coronary angiography

“…Economically and socially disadvantaged women have more symptoms, have a poor quality of life, and decreased survival rates compared to women with higher socioeconomic status [8]. In Sweden, in a study of hospitalized women, László et al [34] found an inverse relationship between personal income and adverse outcomes. The explanation of socioeconomic inequalities in health can be formulated from two assumptions: i) the health selection hypothesis (health selection) and ii) the reverse causality hypothesis (reverse causation) that determine the social position health [35, 36].…”

The contribution of health behaviors to socioeconomic inequalities in health: A systematic review

“…While the majority of the included papers did not provide any direct assessment of the contribution of health behaviors to socioeconomic differences in all-cause mortality and risk of cardiometabolic disorders, in 31 studies this contribution was calculated according to the absolute (n=13) (7,23,28,(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) or relative scale difference methods (n=18) (11,19,21,22,(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60) which compare the beta coefficient for SEP from the unadjusted regression model (Model 1) with the beta coefficient from the regression model additionally adjusted for health behaviors (Model 2). Nine studies provided a quantification of the contribution of health behaviors by using alternative methods, namely path analysis model (61,62), likelihood-ratio test statistic (63), Sobel's mediation test (64)(65)(66) and the mediation method based on direct and indirect effects (67)(68)(69).…”

“…Contribution of health behaviors (%) = 100 × (β Model 1 -β Model 2: Model 1 + health behavior(s))/β Model 1 where β = β regression coefficient or log (HR, OR, RR) of the least advantaged SEP group for studies that used highest SEP group as a reference (n=105). For studies that used the lowest SEP group as a reference, β coefficients from the highest SEP group were used for computing the contribution of health behaviors (38,60,(73)(74)(75)(76)(77)(78)(79). To illustrate the computation of the contribution of health behaviors, we can consider an example taken from a study by Stringhini et al (Table 4 -Whitehall II data) (7).…”

Impact of Severe Earthquake on the Occurrence of Acute Coronary Syndrome and Stroke in a Rural Area of Japan Experience From the Noto Peninsula Earthquake

“…It is interesting to compare the effects of different kinds of stress on the occurrence of ACH and CH. Coronary events in women could increase in the relative long-term 15 and the effect of other factors, such as bankruptcy, should be further sought.…”