Association of socioeconomic status with functional capacity, heart rate recovery, and all-cause mortality

被引:114
作者
Shishehbor, MH
Litaker, D
Pothier, CE
Lauer, MS
机构
[1] Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44195 USA
[2] Louis Stokes Cleveland VA Med Ctr, Dept Med, Cleveland, OH USA
[3] Case Western Reserve Univ, Dept Epidemiol & Biostat, Cleveland, OH 44106 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2006年 / 295卷 / 07期
关键词
D O I
10.1001/jama.295.7.784
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Lower socioeconomic status (SES) confers heightened cardiovascular risk and mortality, although the mediating pathways are unclear. Objective To evaluate the extent to which exercise physiologic characteristics account for the association between lower SES and mortality. Design, Setting, and Participants Prospective cohort study of 30 043 consecutive patients living in 7 counties in northeast Ohio referred between 1990 and 2002 for symptom-limited stress testing for evaluation of known or suspected coronary artery disease. Follow-up for mortality continued through February 2004. Main Outcome Measures Estimated functional capacity in metabolic equivalents and heart rate recovery, physiologic characteristics that are determined directly from exercise; testing and all-cause mortality during a median follow-up of 6.5 years. Results Multivariable models adjusting for demographics, insurance status, smoking status, and clinical confounders demonstrated a strong association between a composite SES score based on census block data and functional capacity (adjusted odds ratio comparing 25th with 75th percentile values, 1.72; 95% confidence interval [CI], 1.56-1.89; P<.001) as well as heart rate recovery (adjusted odds ratio comparing 25th with 75th percentile values, 1.18; 95% CI, 1.07-1.30; P<.001). There were 2174 deaths, with mortality risk increasing from 5% to 10% as SES decreased by quartile (P<.001). Cox proportional hazards models that included all confounding variables except exercise physiologic characteristics demonstrated increased mortality as SES decreased (adjusted hazard ratio comparing 25th with 75th percentile values, 1.32; 95% CI, 1.22-1.42; P<.001). After further adding functional capacity and heart rate recovery, the magnitude of this relationship was reduced (comparing 25th with 75th percentile values; adjusted hazard ratio, 1.17; 95% CI, 1.08-1.26; P<.001), with these variables explaining 47% of the association. Conclusions Impaired functional capacity and abnormal heart rate recovery were strongly associated with lower SES and accounted for a major proportion of the correlation between SES and mortality. Efforts to modify these clinical features among patients with low SES may narrow disparities in mortality.
引用
收藏
页码:784 / 792
页数:9
相关论文
共 60 条
[1]   SOCIOECONOMIC INEQUALITIES IN HEALTH - NO EASY SOLUTION [J].
ADLER, NE ;
BOYCE, WT ;
CHESNEY, MA ;
FOLKMAN, S ;
SYME, SL .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 269 (24) :3140-3145
[2]   Socioeconomic status, service patterns, and perceptions of care among survivors of acute myocardial infarction in Canada [J].
Alter, DA ;
Iron, K ;
Austin, PC ;
Naylor, CD .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2004, 291 (09) :1100-1107
[3]   Mortality effects of community socioeconomic status [J].
Anderson, RT ;
Sorlie, P ;
Backlund, E ;
Johnson, N ;
Kaplan, GA .
EPIDEMIOLOGY, 1997, 8 (01) :42-47
[4]  
Beachler M, 2003, J RURAL HEALTH, V19, P416
[5]   Tracking social and biological experiences - The social etiology of cardiovascular disease [J].
Berkman, LF .
CIRCULATION, 2005, 111 (23) :3022-3024
[6]   Surgeon volume and operative mortality in the United States [J].
Birkmeyer, JD ;
Stukel, TA ;
Siewers, AE ;
Goodney, PP ;
Wennberg, DE ;
Lucas, FL .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 349 (22) :2117-2127
[7]   ACCESS TO MEDICAL-CARE FOR BLACK AND WHITE AMERICANS - A MATTER OF CONTINUING CONCERN [J].
BLENDON, RJ ;
AIKEN, LH ;
FREEMAN, HE ;
COREY, CR .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1989, 261 (02) :278-281
[8]   Socioeconomic status in health research - One size does not fit all [J].
Braveman, PA ;
Cubbin, C ;
Egerter, S ;
Chideya, S ;
Marchi, KS ;
Metzler, M ;
Posner, S .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2005, 294 (22) :2879-2888
[9]  
Centers for Disease Control and Prevention (CDC), 1999, MMWR Morb Mortal Wkly Rep, V48, P143
[10]   COMMUNITY-LEVEL COMPARISONS BETWEEN THE GROCERY STORE ENVIRONMENT AND INDIVIDUAL DIETARY PRACTICES [J].
CHEADLE, A ;
PSATY, BM ;
CURRY, S ;
WAGNER, E ;
DIEHR, P ;
KOEPSELL, T ;
KRISTAL, A .
PREVENTIVE MEDICINE, 1991, 20 (02) :250-261