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      Longitudinal Associations Between Income Changes and Incident Cardiovascular Disease : The Atherosclerosis Risk in Communities Study

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          Abstract

          What is the association between bidirectional income change and cardiovascular disease? In this cohort study of middle-aged, community-dwelling adults, a more than 50% income drop was significantly associated with higher risk of incident cardiovascular disease, while a more than 50% income rise was significantly associated with lower risk of incident cardiovascular disease, over a 17-year follow-up. A negative income change is associated with higher risk of incident cardiovascular disease, while a positive income change is associated with lower risk of incident cardiovascular disease. Higher income is associated with lower incident cardiovascular disease (CVD). However, there is limited research on the association between changes in income and incident CVD. To examine the association between change in household income and subsequent risk of CVD. The Atherosclerosis Risk In Communities (ARIC) study is an ongoing, prospective cohort of 15 792 community-dwelling men and women, of mostly black or white race, from 4 centers in the United States (Jackson, Mississippi; Washington County, Maryland; suburbs of Minneapolis, Minnesota; and Forsyth County, North Carolina), beginning in 1987. For our analysis, participants were followed up until December 31, 2016. Participants were categorized based on whether their household income dropped by more than 50% (income drop), remained unchanged/changed less than 50% (income unchanged), or increased by more than 50% (income rise) over a mean (SD) period of approximately 6 (0.3) years between ARIC visit 1 (1987-1989) and visit 3 (1993-1995). Our primary outcome was incidence of CVD after ARIC visit 3, including myocardial infarction (MI), fatal coronary heart disease, heart failure (HF), or stroke during a mean (SD) of 17 (7) years. Analyses were adjusted for sociodemographic variables, health behaviors, and CVD biomarkers. Of the 8989 included participants (mean [SD] age at enrollment was 53 [6] years, 1820 participants were black [20%], and 3835 participants were men [43%]), 900 participants (10%) experienced an income drop, 6284 participants (70%) had incomes that remained relatively unchanged, and 1805 participants (20%) experienced an income rise. After full adjustment, those with an income drop experienced significantly higher risk of incident CVD compared with those whose incomes remained relatively unchanged (hazard ratio, 1.17; 95% CI, 1.03-1.32). Those with an income rise experienced significantly lower risk of incident CVD compared with those whose incomes remained relatively unchanged (hazard ratio, 0.86; 95% CI, 0.77-0.96). Income drop over 6 years was associated with higher risk of subsequent incident CVD over 17 years, while income rise over 6 years was associated with lower risk of subsequent incident CVD over 17 years. Health professionals should have greater awareness of the influence of income change on the health of their patients. This cohort study examines the association between change in household income and subsequent risk of cardiovascular disease.

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          Most cited references21

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          Poverty impedes cognitive function.

          The poor often behave in less capable ways, which can further perpetuate poverty. We hypothesize that poverty directly impedes cognitive function and present two studies that test this hypothesis. First, we experimentally induced thoughts about finances and found that this reduces cognitive performance among poor but not in well-off participants. Second, we examined the cognitive function of farmers over the planting cycle. We found that the same farmer shows diminished cognitive performance before harvest, when poor, as compared with after harvest, when rich. This cannot be explained by differences in time available, nutrition, or work effort. Nor can it be explained with stress: Although farmers do show more stress before harvest, that does not account for diminished cognitive performance. Instead, it appears that poverty itself reduces cognitive capacity. We suggest that this is because poverty-related concerns consume mental resources, leaving less for other tasks. These data provide a previously unexamined perspective and help explain a spectrum of behaviors among the poor. We discuss some implications for poverty policy.
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            Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: methods and initial two years' experience.

            The community surveillance component of the Atherosclerosis Risk in Communities (ARIC) Study is designed to estimate patterns and trends of coronary heart disease (CHD) incidence, case fatality, and mortality in four U.S. communities. Community surveillance involves ongoing review of death certificates and hospital discharge records to identify CHD events in community residents aged 35-74 years. Interviews with next of kin and questionnaires completed by physicians and medical examiners or coroners were used to collect information on deaths, and review and abstraction of hospital records were used to collect information on possible fatal and nonfatal myocardial infarctions (MIs). Events were classified using standardized criteria. The initial 2-years' experience with case ascertainment and availability of information needed for classification of events is described. Average annual age-adjusted attack rates of definite MI and CHD mortality rates for blacks in two communities and whites in the four communities are presented and compared with rates based on unvalidated hospital discharge data and vital statistics. Age-adjusted rates based on ARIC classification of definite MI were lower than those based on hospital discharge diagnosis code 410 (e.g., 5.60/1000 and 11.50/1000 among Forsyth County white men, respectively). Age-adjusted rates of definite fatal CHD based on ARIC classification were similarly lower than rates based on underlying cause of death code 410; for example, Jackson black men had rates of 2.82/1000 and 4.52/1000 for definite fatal CHD and UCOD 410-414 or 429.2, respectively.
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              Stroke incidence and mortality trends in US communities, 1987 to 2011.

              Prior studies have shown decreases in stroke mortality over time, but data on validated stroke incidence and long-term trends by race are limited.
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                Author and article information

                Journal
                JAMA Cardiology
                JAMA Cardiol
                American Medical Association (AMA)
                2380-6583
                October 09 2019
                Affiliations
                [1 ]Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
                [2 ]Harvard T. H. Chan School of Public Health, Boston, Massachusetts
                [3 ]Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
                [4 ]Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
                [5 ]University of Minnesota School of Public Health, Minneapolis
                [6 ]University of North Carolina Gillings School of Global Public Health, Chapel Hill
                [7 ]University of Kentucky College of Public Health, Lexington
                [8 ]School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
                [9 ]Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
                Article
                10.1001/jamacardio.2019.3788
                6802267
                31596441
                7f7d8340-f2f1-458f-8718-55aae3d15b10
                © 2019
                History

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