Abstract 16708: Socioeconomic Status and the Incidence of Atrial Fibrillation in Whites and African Americans: The Atherosclerosis Risk in Communities (ARIC) Study
Background: Lower socioeconomic status (SES) has been associated with a higher risk of cardiovascular disease (CVD) overall. However, the association of SES and atrial fibrillation (AF) has not been investigated to date.
Methods: We studied 14,352 men and women (75% white, 55% women, mean age 54) free of AF participating in the Atherosclerosis Risk in Communities (ARIC) study. SES was assessed at baseline (1987-89) through educational level and family income. Incident AF cases through 2008 were ascertained from electrocardiograms, hospital discharge codes, and death certificates. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals of AF for education and family income separately. Models were initially adjusted for age, sex, and race. Additional models further adjusted for study site, diabetes, systolic blood pressure, use of antihypertensive medications, smoking status, alcohol consumption, body mass index, and a history of other CVD (heart failure, myocardial infarction, or stroke). Interactions were tested between the measures of SES and race and sex.
Results: Over a median follow-up time of 19.6 years, 1,648 AF cases were identified. Low income was associated with higher AF risk in the entire cohort (table), with no evidence of significant interactions between family income and sex or race. A significant multiplicative interaction was present between sex and education (p<0.0001). Low education was associated with higher AF risk in women but not in men (table). No interaction was found between education and race. Adjustment for cardiovascular risk factors and other CVD strongly attenuated all associations (table, model 2).
Conclusion: Lower SES was associated with a higher AF risk. This association was not different between whites and African Americans; however, the impact of education on risk of AF may be more prominent for women. Cardiovascular risk factors and other CVD likely mediate this association.
- © 2011 by American Heart Association, Inc.