title: Low socioeconomic status over 12 years and subclinical cardiovascular disease: the study of women's health across the nation.
abstract: OBJECTIVE
  The inverse relation between socioeconomic status and cardiovascular disease is well established. However, few studies have investigated socioeconomic status assessed repeatedly during adulthood in relation to subclinical atherosclerosis. We aimed to test whether consistently low socioeconomic status, as indexed by education, income, and financial strain, for 12 years of midlife was related to later carotid intima-media thickness and plaque among women.
  
  
  METHODS
  The Study of Women's Health Across the Nation is a multisite longitudinal study of midlife women. Education was assessed at the study baseline, income and financial strain were obtained yearly for 12 years, and a carotid ultrasound was obtained at study year 12 among 1402 women. Associations were tested in linear and multinomial logistic regression models adjusted for demographic, biological, and behavioral risk factors.
  
  
  RESULTS
  A high school education or less (odds ratio [OR] [95% confidence interval {CI}], 1.72 [1.15-2.59]; P<0.01), some college education (OR [95% CI], 1.65 [1.17-2.32]; P<0.01), consistently low income (OR [95% CI], 1.83 [1.15-2.89]; P<0.05), and consistent financial strain (OR [95% CI], 1.78 [1.21-2.61]; P<0.01) for 12 years were associated with higher carotid plaque, and consistent financial strain was associated with elevated maximal intima-media thickness (β [SE]=0.02 [0.01]; P<0.05) controlling for standard cardiovascular disease risk factors. When socioeconomic status indices were considered together, financial strain (β [SE]=0.02 [0.01]; P<0.05) and low education (high school education or less: OR [95% CI], 1.55 [1.01-2.37]; P<0.05; some college: OR [95% CI], 1.56 [1.09-2.21]; P<0.05) were most consistently associated with intima-media thickness and plaque, respectively, controlling for risk factors.
  
  
  CONCLUSIONS
  The findings indicate the importance of targeting economically disadvantaged women in efforts to prevent cardiovascular disease among women.
authors.affiliation: From the Department of Psychiatry, University of Pittsburgh School of Medicine, PA (R.C.T., K.A.M.); Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (R.C.T., S.R.E.K., E.B.-M., C.K.M., K.A.M.); Department of Epidemiology, Albert Einstein College of Medicine, Bronx, NY (C.A.D.); and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (T.T.L.).
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Thurston
authors.forename: Samar R
authors.initials: SR
authors.lastname: El Khoudary
authors.forename: Carol A
authors.initials: CA
authors.lastname: Derby
authors.forename: Emma
authors.initials: E
authors.lastname: Barinas-Mitchell
authors.forename: Tené T
authors.initials: TT
authors.lastname: Lewis
authors.forename: Candace K
authors.initials: CK
authors.lastname: McClure
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
mesh_terms: D000328:Adult; D001213:Asian / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000191:economics* / Q000453:epidemiology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000191:economics* / Q000453:epidemiology*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008593:Menopause; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D012923:Social Class; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D016387:Women's Health / Q000706:statistics & numerical data*; D001741:Black or African American
keywords: atherosclerosis; cardiovascular diseases; carotid intima-media thickness; education; social class