Socioeconomic Status Indicators and Incidence of Heart Failure Among Men and Women With Coronary Heart Disease

Abstract Background Low socioeconomic status (SES) is associated with increased coronary heart disease (CHD) risk. Little is known about the relationship between SES and heart failure (HF) incidence among CHD patients. Methods and Results The association among education, occupation, and HF risk was studied in 2,951 CHD patients, free of HF at baseline, participating in a clinical trial, correcting for the competing risk of death. Over 8 years of close follow-up, 511 patients developed HF. These patients were older, and had higher frequency of metabolic risk factors and advanced CHD than HF-free counterparts. Age-adjusted HF incidence rate/1,000 person-years increased from 20.4 to 30.0 among patients with academic and elementary education, respectively. The rate for “blue collar” occupation was 25.1 compared with 18.5 among “academic”/“white collar” occupations combined. Adjusting for sex, obesity, diabetes, metabolic syndrome, peripheral vascular disease, hypertension, and myocardial infarction number, the HF hazard ratios [HRs] were 0.85 (95% confidence interval [CI] 0.70–1.03) and 0.76 (95% CI 0.58–0.99) for high-school and academic education versus elementary education, respectively. HR for “blue collar” compared with “academic”/“white collar” occupations was 1.30 (95% CI 0.97–1.74). Conclusions SES indicators (mainly education) are associated with HF incidence among CHD patients. The association is only marginally explained by possible confounders or known mediators such as hypertension and myocardial infarction.