Income disparities in CVD incidence increased from 1999 to 2016
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Disparities in CVD prevalence substantially increased from 1999 to 2016 between patients with high resources and low resources, with the highest-resources group having a lower CVD rate compared with other groups, researchers found.
In this serial cross-sectional study published in JAMA Network Open, Salma M. Abdalla, MBBS, MPH, research fellow at Boston University School of Public Health, and colleagues analyzed data from 44,986 participants aged at least 20 years from the National Health and Nutrition Examination Survey from 1999 to 2016.
Using the income-to-poverty ratio, participants were stratified as having a ratio of 5 or greater, or the highest-resources group (n = 7,926; 50% aged 40-59 years; 52% men), or a ratio of less than 5, which consisted of the remainder of the population (n = 37,060; 34% aged 40-59 years; 47% men).
Outcomes of interested consisted of angina, congestive HF, stroke or MI.
From 1999 to 2016, the age-standardized prevalence of CVD decreased in participants in the highest-resources group, particularly MI (3.2% to 1.4%), angina (3.4% to 0.3%), stroke (1.1% to 1%) and congestive HF (1.2% to 0.5%).
For the remainder of the population, decreases were observed in the prevalence of MI (4% to 3.6%) and angina (3.3% to 2.6%) from 1999 to 2016. In contrast, researchers observed increases in the prevalence of stroke (2.9% to 3.2%) and congestive HF (2.6% to 2.8%).
The odds of reporting CVD decreased over time in participants in the highest-resources group, specifically for MI (OR = 0.91; 95% CI, 0.86-0.87), angina (OR = 0.8; 95% CI, 0.73-0.87) and congestive HF (OR = 0.9; 95% CI, 0.82-0.99). No significant changes were observed for reporting stroke (OR = 0.97; 95% CI, 0.9-1.05).
For the remaining participants, the odds of reporting MI (OR = 0.99; 95% CI, 0.97-1.02) and angina (OR = 0.95; 95% CI, 0.92-0.99) decreased over time. Researchers did not observe statistically significant changes in the odds of reporting stroke (OR = 1.02; 95% CI, 0.99-1.04) and congestive HF (OR = 1.02; 95% CI, 1-1.05).
“These findings should motivate further research into the dynamics of income inequality and health outcomes as well as the potential mechanisms behind these inequalities, such as increasing health care expenditures, behavioral risk factors or other structural factors, which can point to potential solutions,” Abdalla and colleagues wrote. “Mitigating the consequences of these inequality dynamics requires the development of policy and public health efforts.”
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