title: Education, income, and incident heart failure in post-menopausal women: the Women's Health Initiative Hormone Therapy Trials.
abstract: OBJECTIVE
  The purpose of this study is to estimate the effect of education and income on incident heart failure (HF) hospitalization among post-menopausal women.
  
  
  BACKGROUND
  Investigations of socioeconomic status have focused on outcomes after HF diagnosis, not associations with incident HF. We used data from the Women's Health Initiative Hormone Trials to examine the association between socioeconomic status levels and incident HF hospitalization.
  
  
  METHODS
  We included 26,160 healthy, post-menopausal women. Education and income were self-reported. Analysis of variance, chi-square tests, and proportional hazards models were used for statistical analysis, with adjustment for demographics, comorbid conditions, behavioral factors, and hormone and dietary modification assignments.
  
  
  RESULTS
  Women with household incomes <$20,000 a year had higher HF hospitalization incidence (57.3/10,000 person-years) than women with household incomes >$50,000 a year (16.7/10,000 person-years; p < 0.01). Women with less than a high school education had higher HF hospitalization incidence (51.2/10,000 person-years) than college graduates and above (25.5/10,000 person-years; p < 0.01). In multivariable analyses, women with the lowest income levels had 56% higher risk (hazard ratio: 1.56, 95% confidence interval: 1.19 to 2.04) than the highest income women; women with the least amount of education had 21% higher risk for incident HF hospitalization (hazard ratio: 1.21, 95% confidence interval: 0.90 to 1.62) than the most educated women.
  
  
  CONCLUSIONS
  Lower income is associated with an increased incidence of HF hospitalization among healthy, post-menopausal women, whereas multivariable adjustment attenuated the association of education with incident HF.
authors.affiliation: Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. rashmee.shah@cshs.org
authors.forename: Rashmee U
authors.initials: RU
authors.lastname: Shah
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Winkleby
authors.forename: Linda
authors.initials: L
authors.lastname: Van Horn
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Martin
authors.forename: Milagros C
authors.initials: MC
authors.lastname: Rosal
authors.forename: Joann E
authors.initials: JE
authors.lastname: Manson
authors.forename: Hongyan
authors.initials: H
authors.lastname: Ning
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.forename: Liviu
authors.initials: L
authors.lastname: Klein
mesh_terms: D000368:Aged; D004522:Educational Status; D015914:Estrogen Replacement Therapy / Q000191:economics* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000191:economics* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007182:Income; D008875:Middle Aged; D017698:Postmenopause