Association of Socioeconomic Status With Functional Capacity, Heart Rate Recovery, and All-Cause Mortality

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...

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Published in:JAMA : the journal of the American Medical Association 2006-02, Vol.295 (7), p.784-792
Main Authors: Shishehbor, Mehdi H, Litaker, David, Pothier, Claire E, Lauer, Michael S
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Blood pressure
Cardiovascular disease
Cardiovascular Diseases - epidemiology
Cardiovascular Physiological Phenomena
Cohort Studies
Exercise Test
Female
General aspects
Health care policy
Heart Rate
Home ownership
Humans
Income
Logistic Models
Male
Medical sciences
Middle Aged
Mortality
Ohio
Patients
Risk factors
Socioeconomic Factors
Status
Testing
Variables
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container_title JAMA : the journal of the American Medical Association
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creator Shishehbor, Mehdi H
Litaker, David
Pothier, Claire E
Lauer, Michael S
description 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
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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&lt;.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&lt;.001). There were 2174 deaths, with mortality risk increasing from 5% to 10% as SES decreased by quartile (P&lt;.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&lt;.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&lt;.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.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.295.7.784</identifier><identifier>PMID: 16478901</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Blood pressure ; Cardiovascular disease ; Cardiovascular Diseases - epidemiology ; Cardiovascular Physiological Phenomena ; Cohort Studies ; Exercise Test ; Female ; General aspects ; Health care policy ; Heart Rate ; Home ownership ; Humans ; Income ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Mortality ; Ohio ; Patients ; Risk factors ; Socioeconomic Factors ; Status ; Testing ; Variables</subject><ispartof>JAMA : the journal of the American Medical Association, 2006-02, Vol.295 (7), p.784-792</ispartof><rights>2006 INIST-CNRS</rights><rights>Copyright American Medical Association Feb 15, 2006</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a329t-3ef9a3e2bdbd8d283f31be8c33754fe3b88abc3c1ec59d43a778f07c45ce007b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=17483918$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16478901$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shishehbor, Mehdi H</creatorcontrib><creatorcontrib>Litaker, David</creatorcontrib><creatorcontrib>Pothier, Claire E</creatorcontrib><creatorcontrib>Lauer, Michael S</creatorcontrib><title>Association of Socioeconomic Status With Functional Capacity, Heart Rate Recovery, and All-Cause Mortality</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>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&lt;.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&lt;.001). There were 2174 deaths, with mortality risk increasing from 5% to 10% as SES decreased by quartile (P&lt;.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&lt;.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&lt;.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. 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Litaker, David ; Pothier, Claire E ; Lauer, Michael S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a329t-3ef9a3e2bdbd8d283f31be8c33754fe3b88abc3c1ec59d43a778f07c45ce007b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Blood pressure</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cardiovascular Physiological Phenomena</topic><topic>Cohort Studies</topic><topic>Exercise Test</topic><topic>Female</topic><topic>General aspects</topic><topic>Health care policy</topic><topic>Heart Rate</topic><topic>Home ownership</topic><topic>Humans</topic><topic>Income</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Ohio</topic><topic>Patients</topic><topic>Risk factors</topic><topic>Socioeconomic Factors</topic><topic>Status</topic><topic>Testing</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shishehbor, Mehdi H</creatorcontrib><creatorcontrib>Litaker, David</creatorcontrib><creatorcontrib>Pothier, Claire E</creatorcontrib><creatorcontrib>Lauer, Michael S</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium &amp; 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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&lt;.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&lt;.001). There were 2174 deaths, with mortality risk increasing from 5% to 10% as SES decreased by quartile (P&lt;.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&lt;.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&lt;.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.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>16478901</pmid><doi>10.1001/jama.295.7.784</doi><tpages>9</tpages></addata></record>
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source American Medical Association Current Titles
subjects Adult
Aged
Biological and medical sciences
Blood pressure
Cardiovascular disease
Cardiovascular Diseases - epidemiology
Cardiovascular Physiological Phenomena
Cohort Studies
Exercise Test
Female
General aspects
Health care policy
Heart Rate
Home ownership
Humans
Income
Logistic Models
Male
Medical sciences
Middle Aged
Mortality
Ohio
Patients
Risk factors
Socioeconomic Factors
Status
Testing
Variables
title Association of Socioeconomic Status With Functional Capacity, Heart Rate Recovery, and All-Cause Mortality
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