Education, Income, and Incident Heart Failure in Post-Menopausal Women The Women's Health Initiative Hormone Therapy Trials

• Type of Material: Article
• Authors: Rashmee U. Shah, Stanford University; Marilyn A. Winkleby, Stanford University; Linda Van Horn, Northwestern University; Lawrence S Phillips, Emory University; Charles B. Eaton, Brown University; Lisa W. Martin, George Washington University; Milagros C. Rosal, University of Massachusetts; JoAnn E. Manson, Harvard University; Hongyan Ning, Northwestern University; Donald M. Lloyd-Jones, Northwestern University; Liviu Klein, University of California, San Francisco
• Language: English
• Date: 2011-09-27
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2011 American College of Cardiology Foundation.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2011.07.006
• Title of Journal or Parent Work: Journal of the American College of Cardiology
• ISSN: 0735-1097
• Volume: 58
• Issue: 14
• Start Page: 1457
• End Page: 1464
• Grant/Funding Information: The WHI program is funded by the NHLBI through contracts N01WH22110; 24152; 32100-2; 32105-6; 32108-9; 32111-13; 32115; 32118-32119; 32122; 42107-26; 42129-32; and 44221.; Dr. Phillips is supported by VA HSR&D award IIR 07-138.; Dr. Shah is supported by grants from the AHA Pharmaceutical Round Table; and the Stanford NIH/NCRR CTSA grant KL2RR025743.; Dr. Klein is supported by NIH grant R21AG027471.
• Keywords: socioeconomic status; SOCIOECONOMIC-STATUS; LITERACY; women; Cardiovascular System & Cardiology; RISK-FACTORS; Life Sciences & Biomedicine; Science & Technology; heart failure; Cardiac & Cardiovascular Systems
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Objectives: The purpose of this study is to estimate the effect of education and income on incident heart failure (HF) hospitalization among post-menopausal women. Background: Investigations of socioeconomic status have focused on outcomes after HF diagnosis, not associations with incident HF. We used data from the Women's Health Initiative Hormone Trials to examine the association between socioeconomic status levels and incident HF hospitalization. Methods: We included 26,160 healthy, post-menopausal women. Education and income were self-reported. Analysis of variance, chi-square tests, and proportional hazards models were used for statistical analysis, with adjustment for demographics, comorbid conditions, behavioral factors, and hormone and dietary modification assignments. Results: Women with household incomes <$20,000 a year had higher HF hospitalization incidence (57.3/10,000 person-years) than women with household incomes >$50,000 a year (16.7/10,000 person-years; p < 0.01). Women with less than a high school education had higher HF hospitalization incidence (51.2/10,000 person-years) than college graduates and above (25.5/10,000 person-years; p < 0.01). In multivariable analyses, women with the lowest income levels had 56% higher risk (hazard ratio: 1.56, 95% confidence interval: 1.19 to 2.04) than the highest income women; women with the least amount of education had 21% higher risk for incident HF hospitalization (hazard ratio: 1.21, 95% confidence interval: 0.90 to 1.62) than the most educated women. Conclusions: Lower income is associated with an increased incidence of HF hospitalization among healthy, post-menopausal women, whereas multivariable adjustment attenuated the association of education with incident HF.