title: Lower socioeconomic status is associated with worse outcomes in pulmonary arterial hypertension.
abstract: BACKGROUND
  Lower socioeconomic status (SES) confers a heightened risk of common cardiovascular and pulmonary diseases and increased mortality. The association of SES with outcomes in patients with pulmonary arterial hypertension (PAH) is less clear.
  
  
  OBJECTIVE
  To determine the association between SES and outcomes in patients with PAH.
  
  
  METHODS
  We performed a prospective cohort study at a national referral center for patients with PAH in China. Two hundred sixty-two consecutive incident patients aged 18 to 65 years with a diagnosis of idiopathic PAH were recruited between January 2007 and June 2011 and followed up until November 2011. The primary endpoint was all-cause mortality. An SES score for each patient was derived from their educational level, annual household income, occupation, and medical reimbursement rate.
  
  
  RESULTS
  Patients with a lower SES had higher unadjusted mortality rates, with 3-year survival estimates of 50.1, 70.8, and 86.0% in increasing tertiles of SES (P for trend < 0.001). After adjustment for clinical features, hemodynamics, and type of PAH treatment, the hazard ratios for death were 2.98 (95% confidence interval, 1.51-5.89) in the lowest tertile of SES and 1.80 (95% confidence interval, 0.89-3.63) in the middle tertile of SES compared with the upper tertile (P for trend = 0.006).
  
  
  CONCLUSIONS
  A lower SES is strongly associated with a higher risk of death in idiopathic PAH. This association was independent of clinical characteristics, hemodynamics, and treatment. Addressing the health disparities associated with a lower SES may improve the outcomes of patients with PAH.
authors.affiliation: Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Wu
authors.forename: Lu
authors.initials: L
authors.lastname: Yang
authors.forename: Fu-Hua
authors.initials: FH
authors.lastname: Peng
authors.forename: Jing
authors.initials: J
authors.lastname: Yao
authors.forename: Li-Ling
authors.initials: LL
authors.lastname: Zou
authors.forename: Dong
authors.initials: D
authors.lastname: Liu
authors.forename: Xin
authors.initials: X
authors.lastname: Jiang
authors.forename: Jue
authors.initials: J
authors.lastname: Li
authors.forename: Lan
authors.initials: L
authors.lastname: Gao
authors.forename: Jie-Ming
authors.initials: JM
authors.lastname: Qu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kawut
authors.forename: Zhi-Cheng
authors.initials: ZC
authors.lastname: Jing
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012959:Socioeconomic Factors; D016019:Survival Analysis; D055815:Young Adult