Socioeconomic disparities in healthcare utilization for atherosclerotic cardiovascular disease

Jain, Bhav; Bajaj, Simar S.; Paguio, Joseph Alexander; Yao, Jasper Seth; Casipit, Bruce Adrian; Dee, Edward Christopher; Bhatt, Deepak L.

doi:10.1016/j.ahj.2022.01.011

Cited by 2 publications

(3 citation statements)

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“…Most evident is the vocational opportunity provided by education, tied to access to health care in the US. Contemporary data from the National Health Interview Survey demonstrate the cross-sectional association between educational attainment and access to general and specialty care in individuals reporting CVD. Education further shapes vocational circumstances, opportunities, and environmental and psychological exposures relevant to lifelong health beyond the workplace .…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have examined educational attainment as a constituent of socioeconomic position and social determinant in relation to cardiovascular risk and outcomes . Limitations of studies examining the relationship between educational attainment and cardiovascular risk include cross-sectional design, absence of lifetime risk, or absence of accounting for competing risk of death from noncardiovascular disease (CVD) causes . Here, we examined how educational attainment informs lifetime cardiovascular risk assessment by pooling multiple community-based cohorts and examining events into older adulthood.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Limitations of studies examining the relationship between educational attainment and cardiovascular risk include crosssectional design, absence of lifetime risk, or absence of accounting for competing risk of death from noncardiovascular disease (CVD) causes. [11][12][13][14][15] Here, we examined how educational attainment informs lifetime cardiovascular risk assessment by pooling multiple community-based cohorts and examining events into older adulthood. We hypothesized that educational attainment completed in young adulthood would be associated with substantive contributions to cardiovascular lifetime risk and CVD-free longevity in the following decades of life.…”

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confidence: 99%

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Educational Attainment and Lifetime Risk of Cardiovascular Disease

Magnani,

Ning,

Wilkins

et al. 2024

JAMA Cardiol

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ImportanceEducation is a social determinant of health. Quantifying its association with lifetime cardiovascular disease (CVD) risk has public health importance.ObjectiveTo calculate lifetime risk estimates of incident CVD and CVD subtypes and estimate years lived with and without CVD by education.Design, Setting, and ParticipantsIncluded community-based cohort studies with adjudicated cardiovascular events used pooled individual-level data from 1985 to 2015 of 6 prospective cohort studies. The study team assessed the association between education and lifetime CVD risk with modified Kaplan-Meier and Cox models accounting for competing risk of noncardiovascular death. The study team estimated years lived with and without CVD by education with the Irwin restricted mean and the utility of adding educational attainment to CVD risk assessment. Participants (baseline 40 to 59 years old and 60 to 79 years old) were without CVD at baseline and had complete education, cardiovascular risk factors, and prospective CVD outcomes data. Data were analyzed from January 2022 to September 2022.ExposuresEducational attainment (less than high school, high school completion, some college, or college graduate).Main outcome and measuresCardiovascular events (fatal and nonfatal coronary heart disease, heart failure, and stroke; CVD-related deaths; and total CVD encompassing any of these events).ResultsThere were 40 998 participants (23 305 female [56.2%]) with a mean (SD) age of 58.1 (9.7) years for males and 58.3 (9.9) years for females. Compared with college graduates, those with less than high school or high school completion had higher lifetime CVD risks. Among middle-aged men, the competing hazard ratios (HRs) for a CVD event were 1.58 (95% CI, 1.38-1.80), 1.30 (95% CI, 1.10-1.46), and 1.16 (95% CI, 1.00-1.34) in those with less than high school, high school, and some college, respectively, compared with those with college completion. Among women, these competing HRs were 1.70 (95% CI, 1.49-1.95), 1.19 (95% CI, 1.05-1.35), and 0.98 (95% CI, 0.83-1.15). Individuals with higher education had longer duration of life prior to incident CVD. Education provided limited contribution toward enhancing CVD risk prediction.Conclusions and relevanceLower education was associated with lifetime CVD risk across adulthood; higher education translated to healthy longevity. Educational policy initiatives may associate with long-term health benefits.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%