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An unequal social distribution of peripheral arterial disease and the possible explanations: results from a population-based study.
Vasc Med. 2009 Nov; 14(4):289-96.VM

Abstract

A low socioeconomic status (SES) is associated with higher cardiovascular mortality and morbidity. It has remained unclear whether such a social gradient is evident in peripheral artery disease (PAD) because both diseases show different clinical courses. We looked at the association between education and income with PAD within the population of the Heinz Nixdorf Recall Study (HNRS) including 4738 individuals. In both men and women, the ankle-brachial index (ABI) decreased and the prevalence of PAD (ABI < 0.9) increased with decreasing education and income. Looking only at participants without cardiovascular disease, doctor-diagnosed PAD and media calcinosis participants with low (odds ratio 2.58, 95% confidence interval 1.53-4.34) and median education (1.90, 1.27-2.85) had higher odds for suffering from PAD compared to participants with high education. Additional adjustment for classical arteriosclerosis risk factors reduced the strength of the association while the odds ratios remained elevated. Current smoking, diabetes and BMI seem to be the most relevant mediators. Income does not significantly correlate with events when adjustments for all other risk factors are made. In conclusion, our study demonstrates that PAD is more pronounced in men and women with lower socioeconomic status. Diabetes prevention and smoking prevention and cessation programs need to specifically target individuals of lower income and education. According to our findings, prevention of PAD would benefit extraordinarily.

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Authors+Show Affiliations

Kröger K
Department of Angiology, University of Duisburg-Essen, Germany. knut.kroeger@uk-essen.de
Dragano N
No affiliation info available
Stang A
No affiliation info available
Moebus S
No affiliation info available
Möhlenkamp S
No affiliation info available
Mann K
No affiliation info available
Siegrist J
No affiliation info available
Jöckel KH
No affiliation info available
Erbel R
No affiliation info available
Heinz Nixdorf Recall Study Investigator Group
No affiliation info available

MeSH

AgedAnkleBlood PressureBody Mass IndexBrachial ArteryCross-Sectional StudiesDiabetes ComplicationsEducational StatusFemaleGermanyHealth Status DisparitiesHumansIncomeLogistic ModelsMaleMiddle AgedOdds RatioPeripheral Vascular DiseasesPopulation SurveillancePrevalenceProspective StudiesRisk AssessmentRisk FactorsSmokingSocial Class

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19808713

Citation

Kröger, Knut, et al. "An Unequal Social Distribution of Peripheral Arterial Disease and the Possible Explanations: Results From a Population-based Study." Vascular Medicine (London, England), vol. 14, no. 4, 2009, pp. 289-96.
Kröger K, Dragano N, Stang A, et al. An unequal social distribution of peripheral arterial disease and the possible explanations: results from a population-based study. Vasc Med. 2009;14(4):289-96.
Kröger, K., Dragano, N., Stang, A., Moebus, S., Möhlenkamp, S., Mann, K., Siegrist, J., Jöckel, K. H., & Erbel, R. (2009). An unequal social distribution of peripheral arterial disease and the possible explanations: results from a population-based study. Vascular Medicine (London, England), 14(4), 289-96. https://doi.org/10.1177/1358863X09102294
Kröger K, et al. An Unequal Social Distribution of Peripheral Arterial Disease and the Possible Explanations: Results From a Population-based Study. Vasc Med. 2009;14(4):289-96. PubMed PMID: 19808713.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An unequal social distribution of peripheral arterial disease and the possible explanations: results from a population-based study. AU - Kröger,Knut, AU - Dragano,Nico, AU - Stang,Andreas, AU - Moebus,Susanne, AU - Möhlenkamp,Stefan, AU - Mann,Klaus, AU - Siegrist,Johannes, AU - Jöckel,Karl-Heinz, AU - Erbel,Raimund, AU - ,, PY - 2009/10/8/entrez PY - 2009/10/8/pubmed PY - 2009/12/19/medline SP - 289 EP - 96 JF - Vascular medicine (London, England) JO - Vasc Med VL - 14 IS - 4 N2 - A low socioeconomic status (SES) is associated with higher cardiovascular mortality and morbidity. It has remained unclear whether such a social gradient is evident in peripheral artery disease (PAD) because both diseases show different clinical courses. We looked at the association between education and income with PAD within the population of the Heinz Nixdorf Recall Study (HNRS) including 4738 individuals. In both men and women, the ankle-brachial index (ABI) decreased and the prevalence of PAD (ABI < 0.9) increased with decreasing education and income. Looking only at participants without cardiovascular disease, doctor-diagnosed PAD and media calcinosis participants with low (odds ratio 2.58, 95% confidence interval 1.53-4.34) and median education (1.90, 1.27-2.85) had higher odds for suffering from PAD compared to participants with high education. Additional adjustment for classical arteriosclerosis risk factors reduced the strength of the association while the odds ratios remained elevated. Current smoking, diabetes and BMI seem to be the most relevant mediators. Income does not significantly correlate with events when adjustments for all other risk factors are made. In conclusion, our study demonstrates that PAD is more pronounced in men and women with lower socioeconomic status. Diabetes prevention and smoking prevention and cessation programs need to specifically target individuals of lower income and education. According to our findings, prevention of PAD would benefit extraordinarily. SN - 1358-863X UR - https://www.unboundmedicine.com/medline/citation/19808713/An_unequal_social_distribution_of_peripheral_arterial_disease_and_the_possible_explanations:_results_from_a_population_based_study_ L2 - https://journals.sagepub.com/doi/10.1177/1358863X09102294?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -