Background
Methods
Study sample
Outcome
Primary exposure
Covariates
Statistical analysis
Results
Sample characteristics
Characteristics | Overall | High income-high education n = 11155 | Low incomea-high education n = 7955 | High income-low educationb
n = 293 | Low incomea- low educationb
n = 2009 |
P-Value |
---|---|---|---|---|---|---|
Demographics
| ||||||
Age, mean ± SD | 64.1 ± 9.3 | 61.8 ± 8.7 | 65.7 ± 9.4 | 63.7 ± 9.5 | 67.9 ± 9.7 | <.0001 |
Women, n (%) | 12194 (57.0) | 5469 (49.0) | 5338 (67.1) | 113 (38.6) | 1274 (63.4) | <.0001 |
Black, n (%) | 9054 (42.3) | 3549 (31.8) | 3947 (49.6) | 128 (43.7) | 1430 (71.2) | <.0001 |
Region of residence, n (%) | <.0001 | |||||
Nonbelt | 9563 (44.7) | 5222 (46.8) | 3472 (43.7) | 127 (43.3) | 742 (36.9) | |
Stroke Beltc
| 7409 (34.6) | 3594 (32.2) | 2912 (36.6) | 92 (31.4) | 811 (40.4) | |
Stroke Buckled
| 4439 (20.7) | 2338 (21.0) | 1571 (19.8) | 74 (25.3) | 456 (22.7) | |
Urban residence, n (%) | 15213 (78.6) | 7826 (77.4) | 5760 (80.3) | 202 (75.7) | 1425 (79.3) | <.0001 |
Physiologic risk factors
| ||||||
Systolic blood pressure, mm Hg, mean ± SD | 127.1 ± 16.5 | 124.7 ± 15.3 | 129.0 ± 17.0 | 128.7 ± 16.1 | 132.2 ± 18.2 | <.0001 |
Body mass index (kg/m2), mean ± SD | 29.3 ± 6.2 | 28.9 ± 5.7 | 29.7 ± 6.7 | 29.5 ± 5.7 | 30.4 ± 6.8 | <.0001 |
Total cholesterol (mg/dL), mean ± SD | 195.1 ± 39.3 | 194.0 ± 37.3 | 196.7 ± 41.3 | 190.5 ± 39.9 | 193.1 ± 40.6 | 0.75 |
High density lipoprotein cholesterol (mg/dL), mean ± SD | 52.8 ± 16.3 | 52.3 ± 16.3 | 53.1 ± 16.1 | 48.3 ± 14.6 | 51.6 ± 15.4 | 0.18 |
High sensitivity C-reactive protein, median [interquartile range] | 2.2 [0.9–5.0] | 1.8[0.8–4.2] | 2.6[1.1–6.0] | 2.6[1.3–5.7] | 3.2[1.3–6.7] | <.0001 |
Urinary albumin to creatinine Ratio, median [interquartile range] | 7.1 [4.5–14.5] | 6.25[4.2–11.7] | 7.9 [4.9–17.17] | 6.9 [4.4–13.9] | 9.3 [5.2–24.3 | <.0001 |
Health behaviors
| ||||||
Smoking status, n (%) | <.0001 | |||||
Never | 10036 (47.0) | 5446 (49.0) | 3676 (46.4) | 99 (33.9) | 815 (40.7) | |
Past | 8226 (38.5) | 4456 (40.1) | 2872 (36.2) | 139 (47.6) | 759 (37.9) | |
Current | 3085 (14.5) | 1219 (11.0) | 1382 (17.4) | 54 (18.5) | 430 (21.5) | |
No Exercise, n (%) | 6988 (33.1) | 3097 (28.0) | 2939 (37.5) | 97 (34.0) | 855 (43.4) | <.0001 |
Alcohol use, n (%) | <.0001 | |||||
Heavy | 887 (4.2) | 576 (5.2) | 255 (3.3) | 10 (3.5) | 46 (2.4) | |
Moderate | 7271 (34.6) | 4784 (43.5) | 2057 (26.4) | 93 (32.8) | 337 (17.2) | |
None | 12870 (61.2) | 5628 (51.2) | 5486 (70.4) | 181 (63.7) | 1575 (80.4) | |
Medical history
| ||||||
Diabetes, n (%) | 4004 (19.4) | 1548 (14.3) | 1763 (23.1) | 62 (21.8) | 631 (32.9) | <.0001 |
Vascular disease, n (%) | 1373 (13.7) | 435 (3.90) | 655 (8.23) | 24 (8.19) | 259 (12.9) | <.0001 |
Antihypertensive medication use, n (%) | 10312 (48.6) | 4680 (42.3) | 4239 (53.9) | 137 (47.6) | 1256 (63.4) | <.0001 |
Insulin use, n (%) | 953 (4.4) | 316 (2.8) | 445 (5.6) | 11 (3.8) | 181 (9.0) | <.0001 |
Statin use, n (%) | 5980 (28.2) | 3089 (27.9) | 2180 (27.6) | 86 (29.4) | 625 (31.5) | 0.0057 |
Psychosocial measures and insurance coverage
| ||||||
Depressive Symptoms (CES-D ≥4), n (%) | 2163 (10.2) | 631 (5.7) | 1074 (13.6) | 26 (8.9) | 432 (21.6) | <.0001 |
Perceived Stress, median score [interquartile range] | 3.0[0–5.0] | 2.0[0–4.0] | 3.0[1.0–6.0] | 3.0[0–5.0] | 4.0[1.0–7.0] | <.0001 |
Insured, n (%) | 1990 (93.0) | 10840 (97.2) | 7026 (88.4) | 277 (94.5) | 1764 (87.9) | <.0001 |
CHD incidence rates
High income-high education n = 11155 | Low incomea-high education n = 7955 | High income-low educationb
n = 293 | Low incomea- low educationb
n = 2009 | |
---|---|---|---|---|
Events, n | 335 | 325 | 14 | 135 |
Age-adjusted Incidence Rate per 1000 person-years (95 % CI) | 5.2 (4.7–5.8) | 6.3 (5.6–7.1) | 8.1 (4.8–13.7) | 10.1 (8.4–12.1) |
p-value for difference compared to high income/high education |
ref
| 0.02 | 0.10 | <.001 |
Models | ||||
Crude Analysis (95 % CI) |
ref
| 1.42 (1.22–1.65) | 1.66 (0.96–2.86) | 2.51 (2.08–3.03) |
Model 1 HR (95 % CI) |
ref
| 1.40 (1.19–1.64) | 1.43 (0.84–2.45) | 2.15 (1.75–2.63) |
Model 2 HR (95 % CI) |
ref
| 1.10 (0.93–1.29) | 1.18 (0.69–2.02) | 1.45 (1.18–1.80) |
Model 3 HR (95 % CI) |
ref
| 1.07 (0.92–1.27) | 1.18 (0.69–2.03) | 1.42 (1.14–1.76) |
Risk for incident CHD
Differences by age
High income-high education | Low incomea-high education | High income-low educationb
| Low incomea-low educationb
|
P-Value | |
Age | <65 | ||||
N | 7234 | 3696 | 167 | 723 | |
Age, mean ± SD | 56.6 ± 5.00 | 57.5 ± 4.94 | 56.9 ± 5.14 | 58.4 ± 4.70 | <0.001 |
Black, n (%) | 2468 (34.1) | 2115 (57.2) | 69 (41.3) | 525 (72.6) | <0.001 |
Women, n (%) | 3844 (53.1) | 2516 (68.1) | 78 (46.7) | 494 (68.3) | <0.001 |
Had diabetes, n (%) | 932 (13.3) | 878 (24.7) | 28 (17.1) | 220 (31.7) | <0.001 |
Hypertension, n (%) | 3157 (43.7) | 2161 (58.6) | 79 (47.3) | 512 (71.0) | <0.001 |
Antihypertensive medication use, n (%) | 2676 (37.3) | 1845 (36.7) | 61 (37.4) | 445 (62.4) | <0.001 |
Statin use, n (%) | 1758 (24.5) | 881 (24.0) | 39 (23.4) | 199 (27.9) | 0.177 |
Current Smoking, n (%) | 971 (13.5) | 904 (34.5) | 41 (24.7) | 231 (32.0) | <0.001 |
# of Events | 131 | 137 | 3 | 44 | |
Person-years | 42525.61 | 20566.18 | 972.03 | 3803.07 | |
Incidence Rate per 1000 person-years (95 % CI) | 3.0 (2.6–3.6) | 6.4 (5.4–7.6) | 3.0 (1.0–9.4) | 10.8 (8.0–14.6) | |
Crude HR (95 % CI) |
ref
| 2.23 (1.76–2.83) | 0.96 (0.31–3.02) | 3.58 (2.56–4.99) | |
Fully adjusted HR (95 % CI)c
|
ref
| 1.69 (1.30–2.20) | 0.69 (0.22–2.16) | 2.07 (1.42–3.01) | |
Age | ≥65 | ||||
N | 3921 | 4259 | 126 | 1286 | <0.001 |
Age, mean ± SD | 71.4 ± 5.35 | 72.8 ± 5.87 | 72.7 ± 5.76 | 73.3 ± 6.12 | <0.001 |
Black, n (%) | 1082 (27.6) | 1832 (43.0) | 59 (46.8) | 905 (70.4) | <0.001 |
Women, n (%) | 1625 (41.4) | 2822 (66.3) | 35 (27.8) | 780 (60.7) | <0.001 |
Had diabetes, n (%) | 616 (16.2) | 885 (21.7) | 34 (28.1) | 411 (33.6) | <0.001 |
Hypertension, n (%) | 2321 (59.4) | 2782 (65.5) | 87 (69.1) | 934 (72.7) | <0.001 |
Antihypertensive medication use, n (%) | 2005 (51.4) | 2394 (56.8) | 76 (60.1) | 811 (64.0) | <0.001 |
Statin use, n (%) | 1332 (34.3) | 1299 (30.7) | 47 (37.3) | 426 (33.5) | 0.0031 |
Current Smoking, n (%) | 248 (6.34) | 478 (11.3) | 13 (10.3) | 199 (15.5) | <0.001 |
# of Events | 204 | 188 | 11 | 91 | |
Person-years | 23226.34 | 24270.08 | 668.03 | 6874.68 | |
Incidence Rate (95 % CI) | 9.0 (7.8–10.3) | 7.4 (6.4–8.5) | 15.8 (8.8–28.6) | 12.3 (10.0–15.1) | |
Crude HR (95 % CI) |
ref
| 0.88 (0.73–1.07) | 1.82 (1.02–3.25) | 1.58 (1.27–1.98) | |
Fully adjusted HR (95 % CI)c
|
ref
| 0.82 (0.67–1.01) | 1.39 (0.77–2.49) | 1.16 (0.90–1.50) |