Income disparity and incident cardiovascular disease in older Americans

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

doi:10.1016/j.pcad.2021.07.010

Cited by 8 publications

(7 citation statements)

References 38 publications

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“…Another factor associated with chronic myocardial injury in our study was income, with patients with chronic myocardial injury being more likely to earn a lower income than those without myocardial injury.Socioeconomic disadvantage may have put participants at greater risk for chronic myocardial injury due to complicated access to healthcare, suboptimal dietary and exercise habits, and higher likelihood for behaviors like tobacco and alcohol usage. Ultimately, this finding supports longstanding research on poverty as a key risk factor for CVD globally [ 36 – 38 ]. In SSA in particular, action to address systemic issues like poverty will be needed to curb a rising burden of CVD and mitigate health disparities facing socioeconomically disadvantaged patients throughout the region [ 39 ].…”

Section: Discussionsupporting

confidence: 83%

Characteristics and outcomes of patients with symptomatic chronic myocardial injury in a Tanzanian emergency department: A prospective observational study

Rahim,

Sakita,

Coaxum

et al. 2024

PLoS ONE

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Background Chronic myocardial injury is a condition defined by stably elevated cardiac biomarkers without acute myocardial ischemia. Although studies from high-income countries have reported that chronic myocardial injury predicts adverse prognosis, there are no published data about the condition in sub-Saharan Africa. Methods Between November 2020 and January 2023, adult patients with chest pain or shortness of breath were recruited from an emergency department in Moshi, Tanzania. Medical history and point-of-care troponin T (cTnT) assays were obtained from participants; those whose initial and three-hour repeat cTnT values were abnormally elevated but within 11% of each other were defined as having chronic myocardial injury. Mortality was assessed thirty days following enrollment. Results Of 568 enrolled participants, 81 (14.3%) had chronic myocardial injury, 73 (12.9%) had acute myocardial injury, and 412 (72.5%) had undetectable cTnT values. Of participants with chronic myocardial injury, the mean (± sd) age was 61.5 (± 17.2) years, and the most common comorbidities were CKD (n = 65, 80%) and hypertension (n = 60, 74%). After adjusting for CKD, thirty-day mortality rates (38% vs. 36%, aOR 1.03, 95% CI: 0.52–2.03, p = 0.931) were similar between participants with chronic myocardial injury and those with acute myocardial injury, but significantly greater (38% vs. 13.6%, aOR 3.63, 95% CI: 1.98–6.65, p<0.001) among participants with chronic myocardial injury than those with undetectable cTnT values. Conclusion In Tanzania, chronic myocardial injury is a poor prognostic indicator associated with high risk of short-term mortality. Clinicians practicing in this region should triage patients with stably elevated cTn levels in light of their increased risk.

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Section: Discussionsupporting

confidence: 83%

Characteristics and outcomes of patients with symptomatic chronic myocardial injury in a Tanzanian emergency department: A prospective observational study

Rahim,

Sakita,

Coaxum

et al. 2024

PLoS ONE

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“…Briefly, self-reports were confirmed by baseline examination, medical record reviews, surveys of treating physicians, and postbaseline surveillance. Information about annual household income was collected at baseline from all CHS participants during the eligibility phase . Information about physical activity is expressed as metabolic equivalent task-minutes and were calculated from kilocalories of energy expended per week assessed using a modified Minnesota Leisure-Time Activities questionnaire .…”

Section: Methodsmentioning

confidence: 99%

“…Information about annual household income was collected at baseline from all CHS participants during the eligibility phase. 18 Information about physical activity is expressed as metabolic equivalent taskminutes and were calculated from kilocalories of energy expended per week assessed using a modified Minnesota Leisure-Time Activities questionnaire. 19,20 General health was selfreported as excellent, very good, good, fair, or poor.…”

Section: Study Exposure and Other Baseline Measurementsmentioning

confidence: 99%

Assessment of Lung Cancer Risk Among Smokers for Whom Annual Screening Is Not Recommended

et al. 2022

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ImportanceThe US Preventive Services Task Force does not recommend annual lung cancer screening with low-dose computed tomography (LDCT) for adults aged 50 to 80 years who are former smokers with 20 or more pack-years of smoking who quit 15 or more years ago or current smokers with less than 20 pack-years of smoking.ObjectiveTo determine the risk of lung cancer in older smokers for whom LDCT screening is not recommended.Design, Settings, and ParticipantsThis cohort study used the Cardiovascular Health Study (CHS) data sets obtained from the National Heart, Lung and Blood Institute, which also sponsored the study. The CHS enrolled 5888 community-dwelling individuals aged 65 years and older in the US from June 1989 to June 1993 and collected extensive baseline data on smoking history. The current analysis was restricted to 4279 individuals free of cancer who had baseline data on pack-year smoking history and duration of smoking cessation. The current analysis was conducted from January 7, 2022, to May 25, 2022.ExposuresCurrent and prior tobacco use.Main Outcomes and MeasuresIncident lung cancer during a median (IQR) of 13.3 (7.9-18.8) years of follow-up (range, 0 to 22.6) through December 31, 2011. A Fine-Gray subdistribution hazard model was used to estimate incidence of lung cancer in the presence of competing risk of death. Cox cause-specific hazard regression models were used to estimate hazard ratios (HRs) and 95% CIs for incident lung cancer.ResultsThere were 4279 CHS participants (mean [SD] age, 72.8 [5.6] years; 2450 [57.3%] women; 663 [15.5%] African American, 3585 [83.8%] White, and 31 [0.7%] of other race or ethnicity) included in the current analysis. Among the 861 nonheavy smokers (&lt;20 pack-years), the median (IQR) pack-year smoking history was 7.6 (3.3-13.5) pack-years for the 615 former smokers with 15 or more years of smoking cessation, 10.0 (5.3-14.9) pack-years for the 146 former smokers with less than 15 years of smoking cessation, and 11.4 (7.3-14.4) pack-years for the 100 current smokers. Among the 1445 heavy smokers (20 or more pack-years), the median (IQR) pack-year smoking history was 34.8 (26.3-48.0) pack-years for the 516 former smokers with 15 or more years of smoking cessation, 48.0 (35.0-70.0) pack-years for the 497 former smokers with less than 15 years of smoking cessation, and 48.8 (31.6-57.0) pack-years for the 432 current smokers. Incident lung cancer occurred in 10 of 1973 never smokers (0.5%), 5 of 100 current smokers with less than 20 pack-years of smoking (5.0%), and 26 of 516 former smokers with 20 or more pack-years of smoking with 15 or more years of smoking cessation (5.0%). Compared with never smokers, cause-specific HRs for incident lung cancer in the 2 groups for whom LDCT is not recommended were 10.54 (95% CI, 3.60-30.83) for the current nonheavy smokers and 11.19 (95% CI, 5.40-23.21) for the former smokers with 15 or more years of smoking cessation; age, sex, and race–adjusted HRs were 10.06 (95% CI, 3.41-29.70) for the current nonheavy smokers and 10.22 (4.86-21.50) for the former smokers with 15 or more years of smoking cessation compared with never smokers.Conclusions and RelevanceThe findings of this cohort study suggest that there is a high risk of lung cancer among smokers for whom LDCT screening is not recommended, suggesting that prediction models are needed to identify high-risk subsets of these smokers for screening.

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“…Similarly, Elfassy and colleagues observed that income volatility and more than 25% income drop were independently associated with increased risk of incident CVD and mortality among Coronary Artery Risk Development in Young Adults (CARDIA) participants 26 . Faselis et al studied Cardiovascular Health Study (CHS) participants recruited in 1989–1993 and reported that low income (< $16,000) was associated with 16% higher CVD risk and 19% higher mortality risk during follow-up 27 . Our study builds upon existing data by showing that these income related disparities have persisted well into the twenty-first century.…”

Section: Discussionmentioning

confidence: 99%

Family income and cardiovascular disease risk in American adults

Minhas

Jain

et al. 2023

Sci Rep

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Socioeconomic status is an overlooked risk factor for cardiovascular disease (CVD). Low family income is a measure of socioeconomic status and may portend greater CVD risk. Therefore, we assessed the association of family income with cardiovascular risk factor and disease burden in American adults. This retrospective analysis included data from participants aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) cycles between 2005 and 2018. Family income to poverty ratio (PIR) was calculated by dividing family (or individual) income by poverty guidelines specific to the survey year and used as a measure of socioeconomic status. The association of PIR with the presence of cardiovascular risk factors and CVD as well as cardiac mortality and all-cause mortality was examined. We included 35,932 unweighted participants corresponding to 207,073,472 weighted, nationally representative participants. Participants with lower PIR were often female and more likely to belong to race/ethnic minorities (non-Hispanic Black, Mexican American, other Hispanic). In addition, they were less likely to be married/living with a partner, to attain college graduation or higher, or to have health insurance. In adjusted analyses, the prevalence odds of diabetes mellitus, hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke largely decreased in a step-wise manner from highest (≥ 5) to lowest PIR (< 1). In adjusted analysis, we also noted a mostly dose-dependent association of PIR with the risk of all-cause and cardiac mortality during a mean 5.7 and 5.8 years of follow up, respectively. Our study demonstrates a largely dose-dependent association of PIR with hypertension, diabetes mellitus, CHF, CAD and stroke prevalence as well as incident all-cause mortality and cardiac mortality in a nationally representative sample of American adults. Public policy efforts should be directed to alleviate these disparities to help improve cardiovascular outcomes in vulnerable groups with low family income.

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Income disparity and incident cardiovascular disease in older Americans

Cited by 8 publications

References 38 publications

Characteristics and outcomes of patients with symptomatic chronic myocardial injury in a Tanzanian emergency department: A prospective observational study

Characteristics and outcomes of patients with symptomatic chronic myocardial injury in a Tanzanian emergency department: A prospective observational study

Assessment of Lung Cancer Risk Among Smokers for Whom Annual Screening Is Not Recommended

Family income and cardiovascular disease risk in American adults

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