A Novel Socioeconomic Measure Using Individual Housing Data in Cardiovascular Outcome Research
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Setting
2.2. Study Design
2.3. Study Subjects
2.4. Socioeconomic Indicators and HOUSES Index
2.5. Other Variables
2.6. All-Cause Mortality after MI
2.7. Statistical Analysis
3. Results
3.1. Subject Characteristics
3.2. The Association between HOUSES Index and Education Level with Mortality Post-MI
SES Group | Individual Education Level | HOUSES Index | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
1 (Lowest) (n = 100) | 2 (n = 234) | 3 (n = 158) | 4 (Highest) (n = 167) | p | 1 (Lowest) (n = 159) | 2 (n = 159) | 3 (n = 159) | 4 (Highest) (n = 160) | p | |
Median | 8 | 12 | 14 | 16 | −4.3213 | −0.7935 | 0.9718 | 3.3681 | ||
Demographics, n (%) | ||||||||||
Age (years) | 78 ± 13 | 68 ± 14 | 66 ± 15 | 66 ± 15 | <0.001 | 71 ± 16 | 70 ± 14 | 66 ± 14 | 63 ± 14 | <0.001 |
Female | 51 (51) | 114 (49) | 72 (46) | 55 (33) | 0.001 | 90 (57) | 65 (41) | 52 (33) | 57 (36) | <0.001 |
Caucasians | 92 (92) | 226 (97) | 154 (97) | 161 (96) | 0.145 | 146 (92) | 156 (98) | 152 (96) | 154 (96) | 0.146 |
Risk factors, n (%) | ||||||||||
Prior MI | 8 (8) | 13 (6) | 9 (6) | 3 (2) | 0.028 | 17 (11) | 6 (4) | 4 (3) | 5 (3) | 0.002 |
Hypertension | 79 (79) | 168 (72) | 119 (75) | 108 (65) | 0.028 | 121 (76) | 117 (74) | 107 (67) | 105 (66) | 0.019 |
Diabetes | 36 (36) | 58 (25) | 42 (27) | 24 (14) | <0.001 | 46 (29) | 38 (24) | 37 (23) | 33 (21) | 0.092 |
Hyperlipidemia | 56 (56) | 147 (63) | 105 (66) | 93 (56) | 0.783 | 97 (61) | 92 (58) | 100 (63) | 99 (62) | 0.659 |
Current smoker | 15 (15) | 63 (27) | 32 (20) | 15 (9) | 0.008 | 39 (25) | 30 (19) | 36 (23) | 24 (15) | 0.081 |
BMI | 27.9 ± 6.1 | 28.7 ± 6.4 | 28.7 ± 6.4 | 28.6 ± 5.7 | 0.379 | 29.0 ± 6.1 | 29.0 ± 6.5 | 28.1 ± 6.2 | 29.3 ± 6.2 | 0.684 |
MI characteristics and comorbidity, n (%) | ||||||||||
Killip class (n = 639) | ||||||||||
>1 | 40 (42) | 53 (23) | 33 (21) | 39 (24) | 0.011 | 54 (35) | 52 (33) | 30 (19) | 27 (18) | <0.001 |
Anterior MI | 48 (48) | 94 (40) | 52 (33) | 66 (40) | 0.147 | 67 (42) | 72 (45) | 61 (38) | 49 (31) | 0.016 |
ST elevation | 17 (17) | 44 (19) | 29 (18) | 42 (25) | 0.097 | 32 (20) | 29 (18) | 36 (23) | 34 (21) | 0.587 |
Ejection fraction | 0.070 | 0.015 | ||||||||
>50 | 45 (57) | 135 (70) | 86 (68) | 100 (72) | 75 (60) | 94 (69) | 86 (67) | 100 (76) | ||
35–49 | 20 (26) | 40 (21) | 29 (23) | 27 (20) | 33 (27) | 33 (24) | 24 (19) | 23 (18) | ||
<35 | 13 (17) | 17 (9) | 11 (9) | 11 (8) | 16 (13) | 10 (7) | 18 (14) | 8 (6) | ||
Comorbidity index | <0.001 | <0.001 | ||||||||
0 | 13 (13) | 68 (29) | 46 (29) | 79 (47) | 31 (20) | 51 (32) | 61 (38) | 68 (43) | ||
1–2 | 37 (37) | 70 (30) | 69 (44) | 45 (27) | 57 (36) | 56 (35) | 51 (32) | 44 (28) | ||
>3 | 50 (50) | 96 (41) | 43 (27) | 43 (26) | 71 (45) | 52 (33) | 47 (30) | 48 (30) | ||
Treatment | ||||||||||
PTCA | 37 (37) | 109 (47) | 79 (50) | 86 (52) | 0.027 | 67 (42) | 71 (45) | 86 (54) | 82 (51) | 0.038 |
CABG | 8 (8) | 16 (7) | 16 (10) | 10 (6) | 0.803 | 3 (2) | 18 (11) | 13 (8) | 15 (9) | 0.041 |
Statins | 62 (62) | 161 (69) | 111 (70) | 116 (69) | 0.277 | 102 (64) | 110 (69) | 122 (77) | 111 (69) | 0.154 |
β-blockers | 87 (87) | 208 (89) | 150 (95) | 151 (90) | 0.176 | 145 (91) | 147 (92) | 140 (88) | 143 (89) | 0.348 |
Aspirin | 90 (90) | 216 (92) | 149 (94) | 155 (93) | 0.373 | 149 (94) | 147 (92) | 148 (93) | 149 (93) | 0.900 |
HOUSES | 1 Year | 2 Year | Education | 1 Year | 2 Year | ||||
---|---|---|---|---|---|---|---|---|---|
Survival Rate (%) | 95% CI | Survival Rate (%) | 95% CI | Survival Rate (%) | 95% CI | Survival Rate (%) | 95% CI | ||
4 (highest SES) | 89 | 84–94 | 87 | 81–93 | 4 (highest SES) | 85 | 80–91 | 81 | 74–88 |
3 | 86 | 81–92 | 72 | 60–87 | 3 | 87 | 82–93 | 79 | 70–88 |
2 | 82 | 76–88 | 78 | 71–85 | 2 | 83 | 78–88 | 75 | 68–83 |
1 (lowest SES) | 78 | 72–85 | 60 | 50–72 | 1 (lowest SES) | 68 | 59–78 | 47 | 33–67 |
3.3. Identification of Factors that Account for the Association between SES Measures and Post-MI Mortality
Regression Models | HOUSES Index (Quartiles) | Education Level (4 Categories) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
(Hazard Ratio, 95%CI, p-Value) b | (Hazard Ratio, 95%CI, p-Value) b | |||||||||
4 (ref.) (highest SES) | 3 | 2 | 1 (lowest SES) | p a | 4 (ref) (highest SES) | 3 | 2 | 1 (lowest SES) | P a | |
Model 1 (unadjusted model) | 1 | 1.52 | 1.76 | 2.47 | <0.001 | 1 | 1.01 | 1.27 | 2.53 | <0.001 |
(0.85–2.73) | (1.01–3.06) | (1.46–4.19) | (0.59–1.72) | (0.79–2.03) | (1.55–4.14) | |||||
Model 2 | 1 | 1.37 | 1.27 | 1.86 | 0.036 | 1 | 0.95 | 1.16 | 1.84 | 0.015 |
(0.75–2.52) | (0.71–2.26) | (1.07–3.24) | (0.55–1.67) | (0.70–1.90) | (1.11–3.05) | |||||
Model 3 (full model) | 1 | 1.29 | 1.19 | 1.45 | 0.24 | 1 | 0.82 | 0.83 | 0.93 | 0.84 |
(0.68–2.43) | (0.65–2.16) | (0.82–2.58) | (0.46–1.44) | (0.51–1.37) | (0.55–1.57) |
4. Discussion
Unadjusted HRs and 95%CI | HOUSES Index (Quartiles) | Education Level (Quartiles) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
4 (ref) | 3 | 2 | 1 | p a | 4 (ref) | 3 | 2 | 1 | p a | |
1 | 1.52 | 1.76 | 2.47 | <0.001 | 1 | 1.01 | 1.27 | 2.53 | <0.001 | |
(0.85, 2.73) | (1.01, 3.06) | (1.46, 4.19) | (0.59, 1.72) | (0.79, 2.03) | (1.55, 4.14) | |||||
Adjusted HRs for HOUSES Index and Educational Level Controlled for each Variable Listed Below | ||||||||||
Model adjusted for: | ||||||||||
Age | 1 | 1.34 | 1.25 | 1.59 | 0.116 | 1 | 0.99 | 1.19 | 1.48 | 0.089 |
(0.75, 2.40) | (0.72, 2.19) | (0.93, 2.72) | (0.58, 1.69) | (0.75, 1.91) | (0.90, 2.45) | |||||
Comorbidity b | 1 | 1.46 | 1.63 | 1.74 | 0.028 | 1 | 0.75 | 0.83 | 1.33 | 0.186 |
(0.82, 2.63) | (0.93, 2.83) | (1.03, 2.94) | (0.44, 1.29) | (0.51, 1.33) | (0.81, 2.18) | |||||
Female | 1 | 1.52 | 1.73 | 2.31 | 0.002 | 1 | 0.96 | 1.20 | 2.39 | <0.001 |
(0.85, 2.73) | (1.00, 3.01) | (1.35, 3.94) | (0.56, 1.64) | (0.75, 1.92) | (1.46, 3.92) | |||||
White race | 1 | 1.52 | 1.73 | 2.52 | <0.001 | 1 | 0.99 | 1.27 | 2.58 | <0.001 |
(0.85, 2.73) | (0.99, 3.00) | (1.49, 4.26) | (0.58, 1.70) | (0.79, 2.02) | (1.58, 4.21) | |||||
Hypertension | 1 | 1.50 | 1.68 | 2.27 | 0.002 | 1 | 0.94 | 1.21 | 2.34 | <0.001 |
(0.84, 2.69) | (0.97, 2.92) | (1.34, 3.86) | (0.55, 1.62) | (0.75, 1.93) | (1.43, 3.84) | |||||
Diabetes | 1 | 1.50 | 1.75 | 2.35 | 0.001 | 1 | 0.94 | 1.20 | 2.27 | 0.001 |
(0.84, 2.70) | (1.01, 3.04) | (1.39, 3.99) | (0.55, 1.61) | (0.75, 1.92) | (1.37, 3.75) | |||||
Hyperlipidemia | 1 | 1.57 | 1.76 | 2.55 | <0.001 | 1 | 1.07 | 1.34 | 2.54 | <0.001 |
(0.88, 2.82) | (1.01, 3.05) | (1.51, 4.33) | (0.62, 1.83) | (0.84, 2.15) | (1.56, 4.15) | |||||
Current smoker | 1 | 1.55 | 1.76 | 2.56 | <0.001 | 1 | 1.06 | 1.38 | 2.59 | <0.001 |
(0.87, 2.78) | (1.01, 3.06) | (1.51, 4.34) | (0.62, 1.82) | (0.86, 2.22) | (1.58, 4.23) | |||||
BMI | 1 | 1.36 | 1.61 | 2.38 | <0.001 | 1 | 1.03 | 1.32 | 2.44 | <0.001 |
(0.76, 2.43) | (0.93, 2.81) | (1.40, 4.03) | (0.60, 1.76) | (0.82, 2.10) | (1.49, 3.98) | |||||
Killip class > 1 | 1 | 1.37 | 1.41 | 2.14 | 0.005 | 1 | 0.96 | 1.19 | 2.23 | 0.003 |
(0.76, 2.48) | (0.80, 2.49) | (1.26, 3.66) | (0.56, 1.66) | (0.74, 1.91) | (1.35, 3.69) | |||||
Anterior MI | 1 | 1.49 | 1.69 | 2.40 | <0.001 | 1 | 1.02 | 1.25 | 2.44 | <0.001 |
(0.83, 2.67) | (0.97, 2.95) | (1.42, 4.08) | (0.59, 1.75) | (0.78, 2.00) | (1.49, 3.99) | |||||
Ejection fraction | 1 | 1.42 | 1.71 | 2.21 | 0.001 | 1 | 1.02 | 1.28 | 2.41 | <0.001 |
(0.79, 2.54) | (0.98, 2.97) | (1.36, 3.93) | (0.60, 1.75) | (0.80, 2.05) | (1.48, 3.95) | |||||
Aspirin | 1 | 1.50 | 1.75 | 2.46 | <0.001 | 1 | 1.02 | 1.24 | 2.38 | <0.001 |
(0.84, 2.69) | (1.01, 3.04) | (1.45, 4.16) | (0.59, 1.74) | (0.78, 1.99) | (1.46, 3.89) | |||||
β-blockers | 1 | 1.52 | 1.80 | 2.53 | <0.001 | 1 | 1.03 | 1.27 | 2.49 | <0.001 |
(0.85, 2.72) | (1.04, 3.13) | (1.49, 4.29) | (0.60, 1.76) | (0.79, 2.03) | (1.52, 4.07) | |||||
Statins | 1 | 1.68 | 1.78 | 2.39 | 0.001 | 1 | 1.01 | 1.29 | 2.33 | <0.001 |
(0.94, 3.02) | (1.02, 3.09) | (1.41, 4.05) | (0.59, 1.73) | (0.81, 2.07) | (1.42, 3.81) | |||||
PTCA | 1 | 1.62 | 1.66 | 2.25 | 0.003 | 1 | 0.94 | 1.17 | 2.04 | 0.004 |
(0.90, 2.90) | (0.95, 2.88) | (1.33, 3.81) | (0.55, 1.61) | (0.73, 1.88) | (1.25, 3.35) | |||||
CABG | 1 | 1.51 | 1.81 | 2.35 | 0.001 | 1 | 1.04 | 1.28 | 2.62 | <0.001 |
(0.84, 2.72) | (1.04, 3.14) | (1.39, 3.98) | (0.60, 1.78) | (0.80, 2.04) | (1.60, 4.29) |
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Bang, D.W.; Manemann, S.M.; Gerber, Y.; Roger, V.L.; Lohse, C.M.; Rand-Weaver, J.; Krusemark, E.; Yawn, B.P.; Juhn, Y.J. A Novel Socioeconomic Measure Using Individual Housing Data in Cardiovascular Outcome Research. Int. J. Environ. Res. Public Health 2014, 11, 11597-11615. https://doi.org/10.3390/ijerph111111597
Bang DW, Manemann SM, Gerber Y, Roger VL, Lohse CM, Rand-Weaver J, Krusemark E, Yawn BP, Juhn YJ. A Novel Socioeconomic Measure Using Individual Housing Data in Cardiovascular Outcome Research. International Journal of Environmental Research and Public Health. 2014; 11(11):11597-11615. https://doi.org/10.3390/ijerph111111597
Chicago/Turabian StyleBang, Duk Won, Sheila M. Manemann, Yariv Gerber, Veronique L. Roger, Christine M. Lohse, Jennifer Rand-Weaver, Elizabeth Krusemark, Barbara P. Yawn, and Young J. Juhn. 2014. "A Novel Socioeconomic Measure Using Individual Housing Data in Cardiovascular Outcome Research" International Journal of Environmental Research and Public Health 11, no. 11: 11597-11615. https://doi.org/10.3390/ijerph111111597