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Cited by 47Health disparities and outcomesCardiac Health and Mental HealthCardiovascular Health and Risk Factors

Neighborhood socioeconomic status and adverse outcomes in patients with cardiovascular disease

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Topel, Matthew L., Kim, Jeong Hwan, Mujahid, Mahasin S., Sullivan, Samaah M., Ko, Yi-An, Vaccarino, Viola, Quyyumi, Arshed A., Lewis, Tené T.·2019·The American Journal of Cardiology
DOI 10.1016/j.amjcard.2018.10.011PMC PMC6309572
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Abstract

Neighborhood socioeconomic status (nSES) is associated with cardiovascular morbidity and mortality in the general population; however, its effect on high-risk patients with prevalent coronary artery disease (CAD) is unclear. We hypothesized "double jeopardy," whereby the association between nSES and adverse outcomes would be greater in high-risk patients with heart failure (HF) and/or previous myocardial infarction (MI) compared with those without. We followed 3,635 patients (mean age 63.2 years, 42% with HF, 25% with previous MI) with known or suspected CAD over a median of 3.3 years for all-cause death and cardiovascular death or nonfatal MI. Patients were categorized by a composite nSES score, and proportional hazards models were used to determine the association between nSES and outcomes. Cross-product interaction terms for previous MI × nSES and HF × nSES were analyzed. Compared with high nSES patients, low nSES patients had increased risk of all-cause death (hazard ratio [HR] = 1.61; 95% confidence interval [CI] = 1.20, 2.15) and cardiovascular death or MI (subdistribution HR [sHR] = 1.82; 95% CI = 1.30, 2.54). Associations were more pronounced among patients without HF or previous MI. Low nSES patients without HF had a higher risk of all-cause death (HR = 2.27; 95% CI = 1.41, 3.65) compared with those with HF (HR = 1.21; 95% CI = 0.82, 1.77, P interaction = 0.04). Similarly, low nSES patients without previous MI had a higher risk of cardiovascular death or MI (sHR = 2.72; 95% CI = 1.73, 4.28) compared with those with previous MI (sHR = 1.02; 95% CI = 0.58, 1.81, P interaction = 0.02). In conclusion, low nSES was independently associated with all-cause death and cardiovascular death or MI in patients with CAD; however, associations were greater in patients without HF or previous MI compared with those with HF or MI.

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  • Individuals of lower socioeconomic status experience worse cardiovascular outcomes and have higher rates of cardiovascular risk factors.

    “Studies have shown that individuals of lower SES experience worse cardiovascular outcomes and have higher rates of cardiovascular risk factors [5,[21], [22], [23]].”

    From Income disparity and utilization of cardiovascular preventive care services among U.S. adults (2021) · cites this paper as [22]

    The Results report more cardiovascular risk factors and worse outcomes among people living in lower-SES neighborhoods. The cited study measures neighborhood SES in a cohort with cardiovascular disease, not individuals’ own SES or the general population, so the unqualified claim is broader than its findings. (LLM, conf=0.85)

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Cited by

Sorted by citations

Authors
Topel, M. L., Kim, J. H., Mujahid, M. S., Sullivan, S. M., Ko, Y.-A., Vaccarino, V., Quyyumi, A. A., & Lewis, T. T.
Affiliations
  • Emory University (US)
  • University of California, Berkeley (US)
Corresponding author
Topel, Matthew L.
ORCID
Venue
The American Journal of Cardiology
Publisher
Elsevier BV
Published
2019-01
Volume
123
Issue
2
Pages
284-290
ISSN
0002-9149 (ISSN-L)
DOI
10.1016/j.amjcard.2018.10.011
PMC
PMC6309572
OpenAlex
W2896634370
Cited by
47
References
2
Citations by year
2026: 3 · 2025: 9 · 2024: 9 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 7 · 2019: 3
FWCI
4.02
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The American Journal of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (T32 HL130225, HD085850)
  • American Heart Association (0000031288)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
neighborhood socioeconomic status, cardiovascular disease, coronary artery disease, heart failure, old myocardial infarction, all-cause mortality, cardiovascular mortality, myocardial infarction, double jeopardy, social determinants of health
MeSH terms
Coronary Artery Disease, Female, Follow-Up Studies, Georgia, Heart Failure, Humans, Male, Middle Aged, Mortality, Myocardial Infarction, Residence Characteristics, Social Class, Cohort Studies, Proportional Hazards Models

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