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Increased HF risk associated with low socioeconomic status
Shah R. J Am Coll Cardiol. 2011;58:1457-1464.
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Postmenopausal women with lower socioeconomic status have an increased risk for HF hospitalization, according to an analysis of the Women’s Health Initiative hormone trials.
In the trials, 26,160 healthy, postmenopausal women reported education, income and HF hospitalizations. Researchers then used variance, chi-square tests and proportional hazard models adjusted for demographics, comorbid conditions, behavioral factors, and hormone and dietary medication assignments for their statistical analyses.
Overall, 663 incident cases of HF were identified, with 294 meeting Women’s Health Initiative criteria, eight meeting Framingham Heart Study criteria and 361 meeting both.
In the follow-up period, researchers said there was a 56% higher occurrence of incident HF hospitalization among women making less than $20,000 a year vs. women making more than $50,000 a year (P<.01). Between lowest and highest income, researchers said HRs for incident HF hospitalization were similar for women at employment age (HR=1.51; 95% CI, 0.97-2.34) and those at retirement age (HR=1.53; 95% CI, 1.08-2.16).
A higher occurrence of HF hospitalization incidence among women with less than a high school education vs. college graduates (P<.01) was also reported. Incidence in an unadjusted model showed double the hazard for HF hospitalization for women with less than a high school education vs. college graduates (HR=2.01, 95% CI, 1.53-2.65), and incidence in a multivariable model showed a higher hazard of disease in women with lower education (HR=1.21, 95% CI, 0.90-1.62) vs. women with higher education, according to researchers.
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This study with data from the 26,160 post-menopausal women from the Women's Health Initiative Study revealed for the first time that those women with lower SES compared to higher SES had higher subsequent development of HF hospitalization after adjustment of common HF risk factors such as hypertension, diabetes, obesity, interim myocardial infarction. During the 8-year follow-up period, incident HF hospitalization rates decreased from 57.3 to 16.7 per 10,000 person-years between the lowest and highest income categories (p < 0.01). There was a trend for lower education and higher incident HF hospitalization rates. This points out the need for tailored HF prevention efforts to help alleviate the HF health care burden and this health disparity for lower SES post-menopausal women as the aging population increases.
– Jon A. Kobashigawa MD
Cardiology
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