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Longitudinal Associations Between Income Changes and Incident Cardiovascular Disease: The Atherosclerosis Risk in Communities Study.
JAMA Cardiol. 2019 12 01; 4(12):1203-1212.JC

Abstract

Importance

Higher income is associated with lower incident cardiovascular disease (CVD). However, there is limited research on the association between changes in income and incident CVD.

Objective

To examine the association between change in household income and subsequent risk of CVD.

Design, Setting, and Participants

The Atherosclerosis Risk In Communities (ARIC) study is an ongoing, prospective cohort of 15 792 community-dwelling men and women, of mostly black or white race, from 4 centers in the United States (Jackson, Mississippi; Washington County, Maryland; suburbs of Minneapolis, Minnesota; and Forsyth County, North Carolina), beginning in 1987. For our analysis, participants were followed up until December 31, 2016.

Exposures

Participants were categorized based on whether their household income dropped by more than 50% (income drop), remained unchanged/changed less than 50% (income unchanged), or increased by more than 50% (income rise) over a mean (SD) period of approximately 6 (0.3) years between ARIC visit 1 (1987-1989) and visit 3 (1993-1995).

Main Outcomes and Measures

Our primary outcome was incidence of CVD after ARIC visit 3, including myocardial infarction (MI), fatal coronary heart disease, heart failure (HF), or stroke during a mean (SD) of 17 (7) years. Analyses were adjusted for sociodemographic variables, health behaviors, and CVD biomarkers.

Results

Of the 8989 included participants (mean [SD] age at enrollment was 53 [6] years, 1820 participants were black [20%], and 3835 participants were men [43%]), 900 participants (10%) experienced an income drop, 6284 participants (70%) had incomes that remained relatively unchanged, and 1805 participants (20%) experienced an income rise. After full adjustment, those with an income drop experienced significantly higher risk of incident CVD compared with those whose incomes remained relatively unchanged (hazard ratio, 1.17; 95% CI, 1.03-1.32). Those with an income rise experienced significantly lower risk of incident CVD compared with those whose incomes remained relatively unchanged (hazard ratio, 0.86; 95% CI, 0.77-0.96).

Conclusions and Relevance

Income drop over 6 years was associated with higher risk of subsequent incident CVD over 17 years, while income rise over 6 years was associated with lower risk of subsequent incident CVD over 17 years. Health professionals should have greater awareness of the influence of income change on the health of their patients.

Authors+Show Affiliations

Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.Harvard T. H. Chan School of Public Health, Boston, Massachusetts.Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.University of Minnesota School of Public Health, Minneapolis.University of North Carolina Gillings School of Global Public Health, Chapel Hill. University of Kentucky College of Public Health, Lexington.School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Harvard T. H. Chan School of Public Health, Boston, Massachusetts.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31596441

Citation

Wang, Stephen Y., et al. "Longitudinal Associations Between Income Changes and Incident Cardiovascular Disease: the Atherosclerosis Risk in Communities Study." JAMA Cardiology, vol. 4, no. 12, 2019, pp. 1203-1212.
Wang SY, Tan ASL, Claggett B, et al. Longitudinal Associations Between Income Changes and Incident Cardiovascular Disease: The Atherosclerosis Risk in Communities Study. JAMA Cardiol. 2019;4(12):1203-1212.
Wang, S. Y., Tan, A. S. L., Claggett, B., Chandra, A., Khatana, S. A. M., Lutsey, P. L., Kucharska-Newton, A., Koton, S., Solomon, S. D., & Kawachi, I. (2019). Longitudinal Associations Between Income Changes and Incident Cardiovascular Disease: The Atherosclerosis Risk in Communities Study. JAMA Cardiology, 4(12), 1203-1212. https://doi.org/10.1001/jamacardio.2019.3788
Wang SY, et al. Longitudinal Associations Between Income Changes and Incident Cardiovascular Disease: the Atherosclerosis Risk in Communities Study. JAMA Cardiol. 2019 12 1;4(12):1203-1212. PubMed PMID: 31596441.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Longitudinal Associations Between Income Changes and Incident Cardiovascular Disease: The Atherosclerosis Risk in Communities Study. AU - Wang,Stephen Y, AU - Tan,Andy S L, AU - Claggett,Brian, AU - Chandra,Alvin, AU - Khatana,Sameed Ahmed M, AU - Lutsey,Pamela L, AU - Kucharska-Newton,Anna, AU - Koton,Silvia, AU - Solomon,Scott D, AU - Kawachi,Ichiro, PY - 2019/10/10/pubmed PY - 2020/7/14/medline PY - 2019/10/10/entrez SP - 1203 EP - 1212 JF - JAMA cardiology JO - JAMA Cardiol VL - 4 IS - 12 N2 - Importance: Higher income is associated with lower incident cardiovascular disease (CVD). However, there is limited research on the association between changes in income and incident CVD. Objective: To examine the association between change in household income and subsequent risk of CVD. Design, Setting, and Participants: The Atherosclerosis Risk In Communities (ARIC) study is an ongoing, prospective cohort of 15 792 community-dwelling men and women, of mostly black or white race, from 4 centers in the United States (Jackson, Mississippi; Washington County, Maryland; suburbs of Minneapolis, Minnesota; and Forsyth County, North Carolina), beginning in 1987. For our analysis, participants were followed up until December 31, 2016. Exposures: Participants were categorized based on whether their household income dropped by more than 50% (income drop), remained unchanged/changed less than 50% (income unchanged), or increased by more than 50% (income rise) over a mean (SD) period of approximately 6 (0.3) years between ARIC visit 1 (1987-1989) and visit 3 (1993-1995). Main Outcomes and Measures: Our primary outcome was incidence of CVD after ARIC visit 3, including myocardial infarction (MI), fatal coronary heart disease, heart failure (HF), or stroke during a mean (SD) of 17 (7) years. Analyses were adjusted for sociodemographic variables, health behaviors, and CVD biomarkers. Results: Of the 8989 included participants (mean [SD] age at enrollment was 53 [6] years, 1820 participants were black [20%], and 3835 participants were men [43%]), 900 participants (10%) experienced an income drop, 6284 participants (70%) had incomes that remained relatively unchanged, and 1805 participants (20%) experienced an income rise. After full adjustment, those with an income drop experienced significantly higher risk of incident CVD compared with those whose incomes remained relatively unchanged (hazard ratio, 1.17; 95% CI, 1.03-1.32). Those with an income rise experienced significantly lower risk of incident CVD compared with those whose incomes remained relatively unchanged (hazard ratio, 0.86; 95% CI, 0.77-0.96). Conclusions and Relevance: Income drop over 6 years was associated with higher risk of subsequent incident CVD over 17 years, while income rise over 6 years was associated with lower risk of subsequent incident CVD over 17 years. Health professionals should have greater awareness of the influence of income change on the health of their patients. SN - 2380-6591 UR - https://www.unboundmedicine.com/medline/citation/31596441/Longitudinal_Associations_Between_Income_Changes_and_Incident_Cardiovascular_Disease:_The_Atherosclerosis_Risk_in_Communities_Study_ L2 - https://jamanetwork.com/journals/jamacardiology/fullarticle/10.1001/jamacardio.2019.3788 DB - PRIME DP - Unbound Medicine ER -