People in Low-Income Areas Have Worse Cardiac Outcomes

People who live in low-income areas experience less blood pressure control and have worse outcomes from adverse cardiovascular events, according to a study published in the Journal of the American Heart Association (JAHA).

To conduct this study, researchers evaluated 27,862 participants from 623 clinical sites across the United States, Puerto Rico, the Virgin Islands, and Canada from the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack (ALLHAT) Trial. Researchers excluded any participants enrolled in sites outside of the continental United States (n=5,227) due to potential confounders when comparing socioeconomic context of those sites with sites in the continental US. They further restricted their analysis, excluding participants in sites lacking income data (n=304), and subjects randomized to receive doxazosin (n=9,061). They then assessed the effect of socioeconomic context, which was defined in the study as the county‐level median household income, of study sites before stratifying sites into income classifications and comparing characteristics, blood pressure control, and cardiovascular outcomes among ALLHAT participants in the both low‐ and highest‐income categories. Among the qualifying participants, 2,169 (7.8%) received care in the lowest‐income sites and 10,458 (37.6%) received care in the highest‐income sites. Participants in category 1 were more likely to be women, to be black, to be Hispanic, to have fewer years of education, to live in the South, and to have fewer cardiovascular risk factors.

Income Plays a Role

According to the results of the study, 2,169 (7.8%) patients received care in the lowest‐income sites (quintile 1) and 10,458 (37.6%) received care in the highest‐income sites. Participants in the low-income categories were more likely to be women, to be black, to be Hispanic, and to have fewer years of education. They tended to live in the South, and to have fewer cardiovascular risk factors.

Subsequent to baseline demographic adjustment and clinical characteristics assessment, low-income participants were less likely to achieve blood pressure control (<140/90 mm Hg) (OR=0.48; 95% CI, 0.37 to 0.63) and had higher rates of all‐cause mortality (HR=1.25; 95% CI, 1.10–1.41), heart failure hospitalizations/mortality (HR, 1.26; 95% CI, 1.03–1.55), and end‐stage renal disease (HR, 1.86; 95% CI, 1.26–2.73), but lower angina hospitalizations (HR=0.70; 95% CI, 0.59 to 0.83) and coronary revascularizations (HR=0.71; 95% CI, 0.57 to 0.89).

“Typically in a randomized controlled trial where we try to equalize care across treatment arms and across clinical sites, we aim to isolate the effect of a medication to understand its efficacy,” said senior study author Erica Spatz, M.D., an associate professor of medicine at Yale School of Medicine in a press release about the study. “While medications are the mainstay of hypertension control, there are other factors that we need to pay attention to that are impacting blood pressure control, and the ultimate outcomes we care about – heart disease, stroke, hospitalization and longevity.”

Source: JAHA, EurekAlert