The association between socioeconomic position over the life-course and incident heart failure and its case fatality Public Deposited

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  • March 21, 2019
  • Roberts, Calpurnyia Bonyka
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Background: Exposure to disadvantaged socioeconomic circumstances in specific periods over the life-course, prior to the diagnosis of heart failure in older adulthood, may increase the risk of heart failure. Purpose: With eighteen years of follow-up (1987-2004) in the Atherosclerosis Risk in Communities (ARIC), we investigated the impact of individual-level socioeconomic exposures from three distinct life epochs: early childhood (at age 10 years), young adulthood (at age 30 years), and older adulthood (45-64 years), individually and cumulatively, on incident heart failure (HF). Additionally, we examined the bearing of SEP in older adulthood (45-64 years of age) on case fatality in participants with incident HHF. Methods: Incident HF and its case fatality were ascertained via annual follow-up interviews, review of medical records, and death certificates from 1987-2002. Race-specific incidence and hazard rates and 95% confidence intervals were estimated via Cox Proportional Hazard models. Age, gender, ARIC center, and neighborhood-level SEP from each respective life epoch were adjusted for in the analyses. Traditional risk factors of incident HF and case fatality (e.g. hypertension) were treated as mediators since they occur as the result of SEP. Results: Age-adjusted incidence rate (per 1,000 person-years) for incident HF was higher for blacks than whites, 5.23 (95% CI: 4.32, 6.33) and 3.18 (95% CI: 2.81, 3.60), respectively. Possessing a high versus low value for the various SEP exposures across the life-course were associated with an increased risk of incident HF in blacks and whites. Overall, SEP exposures recalled from childhood were the least predictive of incident HF, and SEP exposures from young and older adulthood were among the strongest. The SEP indicators gathered in older adulthood were not significantly associated with case fatality in either blacks or whites. Health insurance was the predominant mediating risk factor in the diagnosis of HF in both blacks and whites. Conclusions: To curtail excess deaths due to socioeconomic inequalities affiliated with HF, more longitudinal studies in diverse populations should be implemented to confirm which life epoch(s) manifest the greatest impact on the occurrence of HF, the particular SEP measures that are the most predictive of HF, and the pathways via which SEP indicators exert their effect on HF.
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  • Heiss, Gerardo
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  • University of North Carolina at Chapel Hill
  • Open access

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