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Socioeconomic Status and Incidence of Hospitalization With Lower-Extremity Peripheral Artery Disease: Atherosclerosis Risk in Communities Study.

TitleSocioeconomic Status and Incidence of Hospitalization With Lower-Extremity Peripheral Artery Disease: Atherosclerosis Risk in Communities Study.
Publication TypeJournal Article
Year of Publication2017
AuthorsVart P, Coresh JJ, Kwak L, Ballew SH, Heiss G
Secondary AuthorsMatsushita K
JournalJ Am Heart Assoc
Volume6
Issue8
Date Published2017 Aug 10
ISSN2047-9980
KeywordsChi-Square Distribution, Female, Health Services Accessibility, Healthcare Disparities, Hospitalization, Humans, Incidence, Income, Kaplan-Meier Estimate, Linear Models, Lower Extremity, Male, Middle Aged, Peripheral Arterial Disease, Poverty, Proportional Hazards Models, Prospective Studies, Risk Factors, Social Class, United States
Abstract

BACKGROUND: Compared to coronary heart disease, heart failure, and stroke, the relationship between low socioeconomic status (SES) and peripheral artery disease (PAD) is less well established. We examined the association between SES and incidence of hospitalization with PAD and explored whether this association can be explained by traditional cardiovascular risk factors and healthcare access.

METHODS AND RESULTS: A total of 12 517 participants in the Atherosclerosis Risk in Communities (ARIC) Study (1987-1989) with no prior PAD were examined. Individual-level SES was assessed from household income (low high school), and area-level SES from area deprivation index (quintiles). During a median follow-up of 23.6 (Interquartile range 19.6-24.5) years, 433 participants had a hospitalization with PAD. In Cox proportional hazards regression analysis, the demographically adjusted hazard ratio was 2.42 (1.81-3.23) for low household income, 2.08 (1.60-2.69) for low educational attainment, and 2.18 (1.35-3.53) for most deprived neighborhoods, compared to their high-SES counterparts. After adjustment for traditional cardiovascular risk factors and heath care access, the associations were attenuated but remained significant, particularly for income and education. Results were consistent when stratified by race (-values for interaction >0.2 for all SES parameters).

CONCLUSIONS: Low individual- and area-level SES are strong predictors of hospitalization with PAD, in part due to increased prevalence of cardiovascular risk factors and poor access to care in these groups. Additional risk factors may also need to be identified and acted on to eliminate SES disparities in PAD hospitalization.

DOI10.1161/JAHA.116.004995
Alternate JournalJ Am Heart Assoc
PubMed ID28862929
PubMed Central IDPMC5586404
Grant ListR21 HL133694 / HL / NHLBI NIH HHS / United States