Importance of socioeconomic status as a predictor of cardiovascular outcome and costs of care in women with suspected myocardial ischemia. Results from the National Institutes of Health, National Heart, Lung and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE).
BACKGROUND
For women, who are more likely to live in poverty, defining the clinical and economic impact of socioeconomic factors may aid in defining redistributive policies to improve healthcare quality.


METHODS
The NIH-NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) enrolled 819 women referred for clinically indicated coronary angiography. This study's primary end point was to evaluate the independent contribution of socioeconomic factors on the estimation of time to cardiovascular death or myocardial infarction (MI) (n = 79) using Cox proportional hazards models. Secondary aims included an examination of cardiovascular costs and quality of life within socioeconomic subsets of women.


RESULTS
In univariable models, socioeconomic factors associated with an elevated risk of cardiovascular death or MI included an annual household income <$20,000 (p = 0.0001), <9th grade education (p = 0.002), being African American, Hispanic, Asian, or American Indian (p = 0.016), on Medicaid, Medicare, or other public health insurance (p < 0.0001), unmarried (p = 0.001), unemployed or employed part-time (p < 0.0001), and working in a service job (p = 0.003). Of these socioeconomic factors, income (p = 0.006) remained a significant predictor of cardiovascular death or MI in risk-adjusted models that controlled for angiographic coronary disease, chest pain symptoms, and cardiac risk factors. Low-income women, with an annual household income <$20,000, were more often uninsured or on public insurance (p < 0.0001) yet had the highest 5-year hospitalization and drug treatment costs (p < 0.0001). Only 17% of low-income women had prescription drug coverage (vs. >or=50% of higher-income households, p < 0.0001), and 64% required >or=2 anti-ischemic medications during follow-up (compared with 45% of those earning >or=$50,000, p < 0.0001).


CONCLUSIONS
Economic disadvantage prominently affects cardiovascular disease outcomes for women with chest pain symptoms. These results further support a profound intertwining between poverty and poor health. Cardiovascular disease management strategies should focus on policies that track unmet healthcare needs and worsening clinical status for low-income women.
Shaw
Leslee J
LJ
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30306, USA. leslee.shaw@emory.edu
Merz
C Noel Bairey
CN
Bittner
Vera
V
Kip
Kevin
K
Johnson
B Delia
BD
Reis
Steven E
SE
Kelsey
Sheryl F
SF
Olson
Marian
M
Mankad
Sunil
S
Sharaf
Barry L
BL
Rogers
William J
WJ
Pohost
Gerald M
GM
Sopko
George
G
Pepine
Carl J
CJ
D000704:Analysis of Variance; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics* / Q000401:mortality*; D015331:Cohort Studies; D017023:Coronary Angiography; D018572:Disease-Free Survival; D005006:Ethnicity; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000401:mortality; D017202:Myocardial Ischemia / Q000191:economics / Q000401:mortality; D054555:National Heart, Lung, and Blood Institute (U.S.); D011203:Poverty; D016016:Proportional Hazards Models; D011788:Quality of Life; D012307:Risk Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016387:Women's Health / Q000191:economics*
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