title: The Association of Socioeconomic Status With Subclinical Myocardial Damage, Incident Cardiovascular Events, and Mortality in the ARIC Study.
abstract: The association between socioeconomic status (SES) and subclinical cardiovascular disease is not well understood. Using data from the Atherosclerosis Risk in Communities Study, we sought to evaluate the cross-sectional and prospective associations of SES, measured by annual income and educational level, with elevated high-sensitivity cardiac troponin T (hs-cTnT) concentrations (≥14 ng/L) using Poisson and multinomial logistic regressions, respectively. We used Cox proportional hazard models to compare the risks of coronary heart disease, heart failure, and mortality according to SES, stratified by baseline hs-cTnT concentration. Our study baseline was 1990-1992, with follow-up through 2011. We found an independent association between SES and hs-cTnT. When comparing participants in the lowest educational level group to those in the highest, the adjusted prevalence ratios for elevated hs-cTnT were 1.36 (95% confidence interval: 1.05, 1.75) overall, 1.83 (95% confidence interval: 1.23, 2.71) in blacks, and 1.05 (95% confidence interval: 0.73, 1.52) in whites (P for interaction = 0.08). Among participants with nonelevated hs-cTnT concentrations, when comparing those in the lowest income groups to those in the highest, the adjusted hazard ratios were strongest for heart failure and death. Having elevated baseline hs-cTnT doubled the risk of heart failure and death. Persons with low SES and elevated hs-cTnT concentrations have the greatest risk of cardiovascular events, which suggests that this group should be aggressively targeted for cardiovascular risk reduction.
authors: Anna
authors: A
authors: Fretz
authors: Andrea L C
authors: AL
authors: Schneider
authors: John W
authors: JW
authors: McEvoy
authors: Ron
authors: R
authors: Hoogeveen
authors: Christie M
authors: CM
authors: Ballantyne
authors: Josef
authors: J
authors: Coresh
authors: Elizabeth
authors: E
authors: Selvin
mesh_terms: D000368:Aged; D050197:Atherosclerosis; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood / Q000209:etiology* / Q000401:mortality*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008396:Maryland; D008875:Middle Aged; D008910:Minnesota; D008922:Mississippi; D009657:North Carolina; D016012:Poisson Distribution; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D012923:Social Class; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: high-sensitivity cardiac troponin T; racial health disparities; social determinants of health; socioeconomic status