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Lower income, education levels linked to higher PAD risk
Among adults in the United States, those with lower income and education levels may be at increased risk for peripheral arterial disease, according to recent findings.
Researchers evaluated data collected from 6,791 participants aged at least 40 years in the National Health and Nutrition Examination Survey from 1999 to 2004. The presence of PAD was determined according to ankle-brachial index, with an ankle-brachial index ≤0.9 indicating PAD. Socioeconomic status was measured according to poverty–income ratio (PIR), which quantifies self-reported household income relative to the poverty line, along with self-reported level of achieved education.
The overall weighted prevalence of PAD was 5.8%. PAD was significantly more common among those with low income and lower levels of education.
Those in the lowest of six PIR categories (<1) had more than twice the risk for PAD vs. those in the highest strata (5 or higher; OR=2.69; 95% CI, 1.8-4.03). Risk was also significantly higher in the second- and third-lowest PIR categories vs. the highest (OR=3.14; 95% CI, 2.2-4.4 for PIR of 1-1.99; OR=2.67; 95% CI, 1.7-4.3 for PIR of 2-2.9). These associations remained significant after adjustment for age, sex and race/ethnicity. The link between increased risk and the lowest PIR category persisted after further adjustment for atherosclerotic risk factors and insurance status (OR=1.64; 95% CI, 1.04-2.6 vs. the highest category).
Dichotomized analysis of PIR indicated significantly increased risk for PAD among those with a PIR below 3 compared with those in higher categories (OR=2.75; 95% CI, 2.2-3.5), which persisted after adjustment for all evaluated confounders.
Researchers noted that a lower level of education was also linked to higher PAD risk, with a significant increase in risk among those with less than a high school education (OR=2.8; 95% CI, 1.96-4) and those with a high school education or some college (OR=1.69; 95% CI, 1.2-2.4) compared with those with a college education or greater. However, this association ceased to be statistically significant after multivariable adjustment.
According to the researchers, prospective studies with incident PAD events are necessary to further elucidate these findings, but they nevertheless serve to highlight an ongoing problem.
“The fact that low [socioeconomic status] is strongly associated with PAD should lead us to better consider our advocacy and education efforts around PAD,” the researchers wrote. “Without question, subpopulations exist here in the United States that remain at substantially higher risk of developing a disease with substantial morbidity and mortality. … We need improved public awareness efforts that are targeted toward these populations within lower socioeconomic strata that remain at risk.”
Disclosure: The researchers report no relevant financial disclosures.