Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 183, Issue 5, Pages 452-461Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwv253
Keywords
high-sensitivity cardiac troponin T; racial health disparities; social determinants of health; socioeconomic status
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Funding
- National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases [R01 DK089174]
- National Heart, Lung, and Blood Institute [HHSN268201100005C, HHSN 268201100006C, HHSN268201100007C, HHSN2682011 00008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, HHSN268201100012C]
- Pollin Cardiovascular Prevention Fellowship
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The association between socioeconomic status (SES) and subclinical cardiovascular disease is not well understood. Using data from the Atherosclerosis Risk in Communities Study, we sought to evaluate the cross-sectional and prospective associations of SES, measured by annual income and educational level, with elevated high-sensitivity cardiac troponin T (hs-cTnT) concentrations (>= 14 ng/L) using Poisson and multinomial logistic regressions, respectively. We used Cox proportional hazard models to compare the risks of coronary heart disease, heart failure, and mortality according to SES, stratified by baseline hs-cTnT concentration. Our study baseline was 1990-1992, with follow-up through 2011. We found an independent association between SES and hs-cTnT. When comparing participants in the lowest educational level group to those in the highest, the adjusted prevalence ratios for elevated hs-cTnT were 1.36 (95% confidence interval: 1.05, 1.75) overall, 1.83 (95% confidence interval: 1.23, 2.71) in blacks, and 1.05 (95% confidence interval: 0.73, 1.52) in whites (P for interaction = 0.08). Among participants with non-elevated hs-cTnT concentrations, when comparing those in the lowest income groups to those in the highest, the adjusted hazard ratios were strongest for heart failure and death. Having elevated baseline hs-cTnT doubled the risk of heart failure and death. Persons with low SES and elevated hs-cTnT concentrations have the greatest risk of cardiovascular events, which suggests that this group should be aggressively targeted for cardiovascular risk reduction.
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