TY - JOUR
T1 - Inequalities in heart failure in older men
T2 - Prospective associations between socioeconomic measures and heart failure incidence in a 10-year follow-up study
AU - Ramsay, Sheena E.
AU - Whincup, Peter H.
AU - Papacosta, Olia
AU - Morris, Richard W.
AU - Lennon, Lucy T.
AU - Goya Wannamethee, S.
PY - 2014/2/1
Y1 - 2014/2/1
N2 - AimsSocioeconomic position has been linked to incident heart failure (HF), but the underlying mechanisms are unclear. We examined the association of socioeconomic measures with incident HF in older adults and examined possible underlying pathways.Methods and resultsA socially representative cohort of men aged 60-79 years in 1998-2000 from 24 British towns was followed-up for 10 years for incident HF. Adult socioeconomic position was based on a cumulative score, including occupation, education, housing tenure, pension, and amenities. Childhood socioeconomic measures included father's occupational social class and household amenities. Prevalent myocardial infarction and HF cases were excluded. Among 3836 men, 229 incident cases of HF occurred over 10 years. Heart failure risk increased with an increasing score of adverse adult socioeconomic measures (P for trend = <0.0001). Compared with men with a score of 0, the hazard ratio for men with a score of ≥4 was 2.19 (95% confidence interval, CI, 1.34-3.55), which was attenuated to 1.87 (95% CI 1.12-3.11) after adjusting for systolic blood pressure, body mass index, smoking, HDL-cholesterol, diabetes, and lung function. Adjustment for left ventricular hypertrophy, atrial fibrillation, heart rate, and renal function made little difference. Further adjustment for C-reactive protein, von Willebrand Factor, N-terminal pro-brain natriuretic peptide, and plasma vitamin C also made little difference to the hazard ratio [1.89 (95% CI 1.10-3.24)]. Heart failure risk did not vary by childhood socioeconomic measures.ConclusionHeart failure risk in older men was greater in the most deprived socioeconomic groups, which was only partly explained by established risk factors for HF. Novel risk factors contribute little to the associated risk.
AB - AimsSocioeconomic position has been linked to incident heart failure (HF), but the underlying mechanisms are unclear. We examined the association of socioeconomic measures with incident HF in older adults and examined possible underlying pathways.Methods and resultsA socially representative cohort of men aged 60-79 years in 1998-2000 from 24 British towns was followed-up for 10 years for incident HF. Adult socioeconomic position was based on a cumulative score, including occupation, education, housing tenure, pension, and amenities. Childhood socioeconomic measures included father's occupational social class and household amenities. Prevalent myocardial infarction and HF cases were excluded. Among 3836 men, 229 incident cases of HF occurred over 10 years. Heart failure risk increased with an increasing score of adverse adult socioeconomic measures (P for trend = <0.0001). Compared with men with a score of 0, the hazard ratio for men with a score of ≥4 was 2.19 (95% confidence interval, CI, 1.34-3.55), which was attenuated to 1.87 (95% CI 1.12-3.11) after adjusting for systolic blood pressure, body mass index, smoking, HDL-cholesterol, diabetes, and lung function. Adjustment for left ventricular hypertrophy, atrial fibrillation, heart rate, and renal function made little difference. Further adjustment for C-reactive protein, von Willebrand Factor, N-terminal pro-brain natriuretic peptide, and plasma vitamin C also made little difference to the hazard ratio [1.89 (95% CI 1.10-3.24)]. Heart failure risk did not vary by childhood socioeconomic measures.ConclusionHeart failure risk in older men was greater in the most deprived socioeconomic groups, which was only partly explained by established risk factors for HF. Novel risk factors contribute little to the associated risk.
KW - Heart failure
KW - Inequalities
KW - Pathways
KW - Socioeconomic factors
UR - http://www.scopus.com/inward/record.url?scp=84894262392&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/eht449
DO - 10.1093/eurheartj/eht449
M3 - Article (Academic Journal)
C2 - 24142349
AN - SCOPUS:84894262392
SN - 0195-668X
VL - 35
SP - 442
EP - 447
JO - European Heart Journal
JF - European Heart Journal
IS - 7
ER -