Longitudinal Associations Between Income Changes and Incident Cardiovascular Disease: The Atherosclerosis Risk in Communities Study

1. Income drop is associated with a higher risk of subsequent cardiovascular disease, while income rise is associated with a lower risk of subsequent cardiovascular disease.

Evidence Rating Level: 2 (Good)

Low income has been robustly associated with an increased risk of cardiovascular disease (CVD). However, causality remains disputed, principally due to assertions that low income may be a marker of other characteristics that predict worse health maintenance behaviors. Therefore, it is critical to examine the impact of income changes on CVD to attempt to infer causality. In this retrospective cohort study, a subset of 8,989 men and women originally enrolled in the Atherosclerosis Risk in Communities (ARIC) study, an ongoing cohort of community-dwelling men and women in 4 US geographic regions, were studied to examine the association between change in household income and subsequent risk of incident CVD, comprising definite or probable MI, fatal coronary heart disease (CHD), incident heart failure (HF), or definite or probable stroke. Data censoring for this study was performed on December 31, 2016. In the approximately 6-year period between the first and third ARIC visits, 10% of participants experienced an income drop, (with mean household incomes falling from $40,516 to $14,655), 70% had incomes that remained relatively unchanged (with mean household incomes remaining similar from $43,897 to $43,057), and 20% experienced an income rise, (with mean household incomes rising from $26,099 to $53,347). After adjusting for all covariates, researchers found that those with an income drop had a significantly higher risk of incident CVD compared to those whose incomes remained relatively unchanged (HR 1.17, 95% CI 1.03 to 1.32), while those with an income rise had a significantly lower risk of incident CVD compared with those whose incomes remained relatively unchanged (HR 0.86, 95% CI 0.77 to 0.96). In fully adjusted analysis, white participants had a higher risk of incident CVD from an income drop compared with black participants (HR for white race 1.28, 95% CI 1.11 to 1.48 vs. HR for black race 1.01, 95% CI 0.79 to 1.29). Women had a lower risk of incident CVD from an income rise compared with men (HR for women 0.74, 95% CI 0.63 to 0.87 vs. HR for men 1.01, 95% CI 0.86 to 1.18). Overall, this study underlines the significant association between income and risk of cardiovascular disease, and emphasizes the need to increase awareness among healthcare providers of the impact of income changes on health.

Click to read the study in JAMA

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