title: Detrimental impact of socioeconomic status on exercise capacity in adults with congenital heart disease.
abstract: OBJECTIVE
  To evaluate the relationship between socioeconomic status (SES), access to physical activity resources, urban-rural dwelling, levels of pollution and exercise capacity in adult congenital heart disease (ACHD) patients.
  
  
  BACKGROUND
  Exercise intolerance is prevalent in ACHD and the contributing factors are poorly understood.
  
  
  METHODS
  A total of 1268 ACHD patients living in England who underwent cardiopulmonary exercise testing at our center were included. Neighborhood deprivation (English Indices of Deprivation), urban-rural dwelling, availability of green space, distance to the closest gym/fitness center and levels of pollution were estimated based on administrative data.
  
  
  RESULTS
  Urban-rural dwelling, availability of green space and levels of pollution were unrelated to exercise capacity. Lower SES was associated with a significantly lower peak oxygen consumption (P<0.002) and heart rate reserve (P<0.004). This association was non-linear and most pronounced in ACHD patients with cardiac defects of medium complexity living in the most socioeconomically disadvantaged communities. Low SES was associated with higher prevalence of diabetes (P=0.015) and smoking (P=0.01). Coronary artery disease was rare in this young population and low SES was found to be related to exercise capacity independently of the presence of coronary artery disease.
  
  
  CONCLUSIONS
  Living in poorer areas is associated with exercise intolerance in contemporary ACHD patients. Although low SES is linked to traditional cardiovascular risk factors, the deleterious effects of SES on exercise capacity seem to be only partially mediated via coronary artery disease. Reducing social inequalities in ACHD patients may have a positive effect on quality of life and long-term prognostic implications.
authors.affiliation: Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Sydney Street, London, UK. g.diller@imperial.ac.uk
authors.forename: Gerhard-Paul
authors.initials: GP
authors.lastname: Diller
authors.forename: Ryo
authors.initials: R
authors.lastname: Inuzuka
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kempny
authors.forename: Rafael
authors.initials: R
authors.lastname: Alonso-Gonzalez
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Liodakis
authors.forename: Francesco
authors.initials: F
authors.lastname: Borgia
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lockhart
authors.forename: Matina
authors.initials: M
authors.lastname: Prapa
authors.forename: Astrid E
authors.initials: AE
authors.lastname: Lammers
authors.forename: Lorna
authors.initials: L
authors.lastname: Swan
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dimopoulos
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
mesh_terms: D000328:Adult; D004739:England / Q000453:epidemiology; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000191:economics* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D012111:Residence Characteristics; D012307:Risk Factors; D012923:Social Class; D055815:Young Adult