The association of personal and neighborhood socioeconomic indicators with subclinical cardiovascular disease in an elderly cohort. The cardiovascular health study
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There has been recent interest in determining whether neighborhood characteristics are related to the cardiovascular health of residents. However, there are no data regarding the relationship between neighborhood socioeconomic status (SES) and prevalence of subclinical cardiovascular disease (CVD) in the elderly. We related personal SES (education, income, and occupation type) and neighborhood socioeconomic characteristics (a block-group score summing six variables reflecting neighborhood income and wealth, education, and occupation) to the prevalence of subclinical CVD (asymptomatic peripheral vascular disease or carotid atherosclerosis, electrocardiogram or echocardiogram abnormalities, and/or positive responses to Rose Questionnaire claudication or angina pectoris) among 3545 persons aged 65 and over, without prevalent CVD, in the Cardiovascular Health Study. Sixty percent of participants had at least one indicator of subclinical disease. Compared to those without, those with subclinical disease had significantly lower education, income, and neighborhood scores and were more likely to have blue-collar jobs. After adjustment for age, gender, and race, those in the lowest SES groups had increased prevalence of subclinical disease compared with those in the highest SES groups (OR = 1.50; 95% CI 1.21, 1.86 for income; OR = 1.41; 95% CI 1.18, 1.69 for education; OR = 1.39; 95% CI 1.16, 1.67 for block-group score). Those reporting a blue-collar lifetime occupation had greater prevalence of subclinical disease relative to those reporting a white-collar occupation (OR = 1.29; 95% CI 1.02-1.59). After adjustment for behavioral and biomedical risk factors, all of these associations were reduced. Neighborhood score tended to remain inversely associated with subclinical disease after adjustment for personal socioeconomic indicators but associations were not statistically significant. Personal income and blue-collar occupation remained significantly associated with subclinical disease after simultaneous adjustment for neighborhood score and education. Personal and neighborhood socioeconomic indicators were associated with subclinical disease prevalence in this elderly cohort. These relationships were reduced after controlling for traditional CVD risk factors.
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Socioeconomic status is inversely associated with all phases of CVD progression, from the onset of risk factors through mortality due to CVD.
“The inverse association of socioeconomic status (SES) with all phases of the progression of CVD is well established, from the onset of risk factors through mortality due to CVD [41-45].”
From Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai’i and California (2023) · cites this paper as [45]
The Introduction (page not provided) reports inverse associations between socioeconomic position and CVD prevalence and incidence, and discusses socioeconomic differences in CVD risk factors. The Discussion (page not provided) reports an association with subclinical disease in older adults. Our copy does not establish the claimed association across all phases through CVD mortality. (LLM, conf=0.87)
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- Authors
- Nordstrom, C. K., Diez Roux, A. V., Jackson, S. A., & Gardin, J. M.
- Affiliations
- University of Michigan (US)
- Wake Forest University Health Sciences (US)
- Wayne State University (US)
- Corresponding author
- Nordstrom, Cheryl K.
- ORCID
- Gardin, Julius M.
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2004-11
- Volume
- 59
- Issue
- 10
- Pages
- 2139-2147
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W1981780211
- Cited by
- 131
- References
- 4
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 2 · 2020: 6 · 2019: 4 · 2018: 4 · 2017: 2 · 2016: 8 · 2015: 4 · 2014: 6 · 2013: 6 · 2012: 8
- FWCI
- 7.30
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Wake Forest University
- University of Washington
- Johns Hopkins University
- University of Pittsburgh
- National Institutes of Health (n01hc085082-026, n01hc085081-021, n01hc085079-024, n01hc085084-005, n01hc085085-011, n01hc085083-027, n01hc085080-026, n01hc085086-022, RC-HL35129, 5p60hl015103-15, 5r29hl059386-05, RC-HL15103)
- University of California, Irvine
- National Heart, Lung, and Blood Institute (N01-HC-85081, N01HC85085, N01HC-85083, R29 HL59386, N01HC85082, N01 HC85086, N01HC85080, N01-HC85079, N01-HC85084)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Social Sciences › Health › Public Health and Social Inequalities
- Keywords
- subclinical cardiovascular disease, neighborhood socioeconomic status, older adults, peripheral vascular disease, carotid atherosclerosis, blue-collar occupations, income, cardiovascular risk factors, Cardiovascular Health Study
- MeSH terms
- Aged, California, Cardiovascular Diseases, Female, Geography, Medicare, Humans, Male, Maryland, North Carolina, Pennsylvania, Surveys and Questionnaires, Residence Characteristics, Risk Factors, Social Class, Socioeconomic Factors, Cohort Studies
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