Advertisement

International Journal of Public Health

, Volume 60, Issue 5, pp 573–588 | Cite as

US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings

  • Roman PabayoEmail author
  • Ichiro Kawachi
  • Stephen E. Gilman
Original Article

Abstract

Objectives

To examine prospectively the association between US state income inequality and incidence of heart attack.

Methods

We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,445). Respondents completed interviews at baseline (2001–2002) and follow-up (2004–2005). Weighted multilevel modeling was used to determine if US state-level income inequality (measured by the Gini coefficient) at baseline was a predictor of heart attack during follow-up, controlling for individual-level and state-level covariates.

Results

In comparison to residents of US states in the lowest quartile of income inequality, those living in the second [Adjusted Odds Ratio (AOR) = 1.71, 95 % CI 1.16–2.53)], third (AOR = 1.81, 95 % CI 1.28–2.57), and fourth (AOR = 2.04, 95 % CI 1.26–3.29) quartiles were more likely to have a heart attack. Similar findings were obtained when we excluded those who had a heart attack prior to baseline.

Conclusions

This study is one of the first to empirically show the longitudinal relationship between income inequality and coronary heart disease. Living in a state with higher income inequality increases the risk for heart attack among US adults.

Keywords

Income inequality Coronary heart disease Social determinants of health Multilevel modeling Longitudinal analysis Population-based study 

Notes

Acknowledgments

This work was supported by NIH-grant number MH087544. RP was a Canadian Institutes of Health Research postdoctoral fellowship recipient #234617.

Supplementary material

38_2015_678_MOESM1_ESM.pdf (76 kb)
Supplementary material 1 (PDF 76 kb)

References

  1. Adjaye-Gbewonyo K, Kawachi I (2012) Use of the Yitzhaki Index as a test of relative deprivation for health outcomes: a review of recent literature. Soc Sci Med 75(1):129–137. doi: 10.1016/j.socscimed.2012.03.004 PubMedCrossRefGoogle Scholar
  2. Alamian A, Paradis G (2009) Clustering of chronic disease behavioral risk factors in Canadian children and adolescents. Prev Med 48(5):493–499. doi: 10.1016/j.ypmed.2009.02.015 PubMedCrossRefGoogle Scholar
  3. Baumeister RF, DeWall CN, Ciarocco NJ et al (2005) Social exclusion impairs self-regulation. J Pers Soc Psychol 88(4):589–604. doi: 10.1037/0022-3514.88.4.589 PubMedCrossRefGoogle Scholar
  4. Berkman LF, Kawachi I, Glymour M (2014) Social epidemiology, 2nd edn. Oxford University PressGoogle Scholar
  5. Cirera L, Huerta JM, Chirlaque MD et al (2013) Unfavourable life-course social gradient of coronary heart disease within Spain: a low-incidence welfare-state country. Int J Public Health 58(1):65–77. doi: 10.1007/s00038-012-0374-9 PubMedCrossRefGoogle Scholar
  6. Clark AM, DesMeules M, Luo W et al (2009) Socioeconomic status and cardiovascular disease: risks and implications for care. Nat Rev Cardiol 6(11):712–722. doi: 10.1038/nrcardio.2009.163 PubMedCrossRefGoogle Scholar
  7. Clark CR, Ridker PM, Ommerborn MJ et al (2012) Cardiovascular inflammation in healthy women: multilevel associations with state-level prosperity, productivity and income inequality. BMC Public Health 12:211. doi: 10.1186/1471-2458-12-211 PubMedCentralPubMedCrossRefGoogle Scholar
  8. Cradock AL, Kawachi I, Colditz GA et al (2009) Neighborhood social cohesion and youth participation in physical activity in Chicago. Soc Sci Med 68(3):427–435. doi: 10.1016/j.socscimed.2008.10.028 PubMedCrossRefGoogle Scholar
  9. Diez-Roux AV, Link BG, Northridge ME (2000) A multilevel analysis of income inequality and cardiovascular disease risk factors. Soc Sci Med 50(5):673–687PubMedCrossRefGoogle Scholar
  10. Due P, Damsgaard MT, Rasmussen M et al (2009) Socioeconomic position, macroeconomic environment and overweight among adolescents in 35 countries. Int J Obes 33(10):1084–1093. doi: 10.1038/ijo.2009.128 CrossRefGoogle Scholar
  11. Eibner C, Sturn R, Gresenz CR (2004) Does relative deprivation predict the need for mental health services? J Ment Health Policy 7(4):167–175Google Scholar
  12. Franks P, Winters PC, Tancredi DJ et al (2011) Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease? BMC Cardiovasc Disord 11:28. doi: 10.1186/1471-2261-11-28 PubMedCentralPubMedCrossRefGoogle Scholar
  13. Galea S, Ahern J, Tracy M et al (2007) Neighborhood income and income distribution and the use of cigarettes, alcohol, and marijuana. Am J Prev Med 32(6 Suppl):S195–S202. doi: 10.1016/j.amepre.2007.04.003 PubMedCentralPubMedCrossRefGoogle Scholar
  14. Go AS, Mozaffarian D, Roger VL et al (2013a) Executive summary: heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation 127(1):143–152. doi: 10.1161/CIR.0b013e318282ab8f PubMedCrossRefGoogle Scholar
  15. Go AS, Mozaffarian D, Roger VL et al (2013b) Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation 127(1):e6–e245. doi: 10.1161/CIR.0b013e31828124ad PubMedCrossRefGoogle Scholar
  16. Grant BF, Dawson DA, Hasin DS (2001) The alcohol use disorder and associated disabilities interview schedul-DSM-IV version. National Institute on Alcohol Abuse and Alcoholism, BethesdaGoogle Scholar
  17. Grant BF, Dawson DA, Stinson FS et al (2004) The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug Alcohol Depend 74(3):223–234. doi: 10.1016/j.drugalcdep.2004.02.004 PubMedCrossRefGoogle Scholar
  18. Grant BF, Goldstein RB, Chou SP et al (2009) Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Mol Psychiatry 14(11):1051–1066. doi: 10.1038/mp.2008.41 PubMedCentralPubMedCrossRefGoogle Scholar
  19. Hisnanick JJ, Rogers AL (2007) Household income inequality measured based on the ACS data: 2000–2005 program participation and income transfers branch. Housing and Household Economic Statistics Division. U.S. Census BureauGoogle Scholar
  20. Hoyert DL, Xu J (2012) Deaths: Preliminary Data for 2011. In: Statistics DoV (ed). vol 61. National Vital Statistics ReportsGoogle Scholar
  21. Kawachi I, Kennedy BP (1999) Income inequality and health: pathways and mechanisms. Health Serv Res 34(1 Pt 2):215–227PubMedCentralPubMedGoogle Scholar
  22. Kawachi I, Sparrow D, Vokonas PS et al (1994) Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study. Circulation 90(5):2225–2229PubMedCrossRefGoogle Scholar
  23. Kennedy BP, Kawachi I, Prothrow-Stith D (1996) Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States. BMJ 312(7037):1004–1007PubMedCentralPubMedCrossRefGoogle Scholar
  24. Kim D, Kawachi I, Hoorn SV et al (2008) Is inequality at the heart of it? Cross-country associations of income inequality with cardiovascular diseases and risk factors. Soc Sci Med 66(8):1719–1732. doi: 10.1016/j.socscimed.2007.12.030 PubMedCrossRefGoogle Scholar
  25. Kochanek KD, Xu J, Murphy BS, et al (2011) Deaths: final data for 2009. In: Statistics DoV (ed). vol 60. National Vital Statistics ReportsGoogle Scholar
  26. Kondo N, Sembajwe G, Kawachi I et al (2009) Income inequality, mortality, and self rated health: meta-analysis of multilevel studies. BMJ 339:b4471. doi: 10.1136/bmj.b4471 PubMedCentralPubMedCrossRefGoogle Scholar
  27. Lindenauer PK, Lagu T, Rothberg MB et al (2013) Income inequality and 30 day outcomes after acute myocardial infarction, heart failure, and pneumonia: retrospective cohort study. BMJ 346:f521. doi: 10.1136/bmj.f521 PubMedCentralPubMedCrossRefGoogle Scholar
  28. Loucks EB, Lynch JW, Pilote L et al (2009) Life-course socioeconomic position and incidence of coronary heart disease: the Framingham Offspring Study. Am J Epidemiol 169(7):829–836. doi: 10.1093/aje/kwn403 PubMedCentralPubMedCrossRefGoogle Scholar
  29. Luksiene DI, Baceviciene M, Tamosiunas A et al (2011) Health, alcohol and psychosocial factors in Eastern Europe study: dietary patterns and their association with socio-demographic factors in the Lithuanian urban population of Kaunas city. Int J Public Health 56(2):209–216. doi: 10.1007/s00038-010-0170-3 PubMedCentralPubMedCrossRefGoogle Scholar
  30. Marmot M (2005) Social determinants of health inequalities. Lancet 365(9464):1099–1104. doi: 10.1016/S0140-6736(05)71146-6 PubMedCrossRefGoogle Scholar
  31. Massing MW, Rosamond WD, Wing SB et al (2004) Income, income inequality, and cardiovascular disease mortality: relations among county populations of the United States, 1985 to 1994. South Med J 97(5):475–484PubMedCrossRefGoogle Scholar
  32. McNeill LH, Kreuter MW, Subramanian SV (2006) Social environment and physical activity: a review of concepts and evidence. Soc Sci Med 63(4):1011–1022. doi: 10.1016/j.socscimed.2006.03.012 PubMedCrossRefGoogle Scholar
  33. Centers for Disease Control and Prevention (2011) Million hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors–United States. MMWR Morb Mortal Wkly Rep 60(36):1248–1251Google Scholar
  34. Ng DM, Jeffery RW (2003) Relationships between perceived stress and health behaviors in a sample of working adults. Health Psychol 22(6):638–642. doi: 10.1037/0278-6133.22.6.638 PubMedCrossRefGoogle Scholar
  35. OECD (2011) Growing income inequality in OECD countries: what drives it and how can policy tackle it?Google Scholar
  36. Oliver G, Wardle J, Gibson EL (2000) Stress and food choice: a laboratory study. Psychosom Med 62(6):853–865PubMedCrossRefGoogle Scholar
  37. Patterson JM, Eberly LE, Ding Y, Hargreaves M (2004) Associations of smoking prevalence with individual and area level social cohesion. J Epidemiol Community Health 58(8):692–697. doi: 10.1136/jech.2003.009167-&gt PubMedCentralPubMedCrossRefGoogle Scholar
  38. Pendleton VR, Willems E, Swank P et al (2001) Negative stress and the outcome of treatment for binge eating. Eat Disord 9(4):351–360. doi: 10.1080/106402601753454912 PubMedCrossRefGoogle Scholar
  39. Pickett KE, Wilkinson RG (2009) The spirit level: why greater equality makes societies stronger. Bloomsbury Press, New YorkGoogle Scholar
  40. Piketty T (2014) Capital in the Twenty-First Century (trans: Goldhammer A). Harvard University Press, United StatesGoogle Scholar
  41. Raudenbush SW, Bryk AS (2002) Hierarchical linear models: applications and data analysis methods (Advanced Quantitative Techniques in Social Sciences), 2nd edn. Sage Publications Inc, Thousand OaksGoogle Scholar
  42. Reitzel LR, Kendzor DE, Castro Y et al (2013) The relation between social cohesion and smoking cessation among Black smokers, and the potential role of psychosocial mediators. Ann Behav Med 45(2):249–257. doi: 10.1007/s12160-012-9438-6 PubMedCentralPubMedCrossRefGoogle Scholar
  43. Shankar A, McMunn A, Banks J, Steptoe A (2011) Loneliness, social isolation, and behavioral and biological health indicators in older adults. Health Psychol 30(4):377–385. doi: 10.1037/a0022826 PubMedCrossRefGoogle Scholar
  44. Sharma S, Malarcher AM, Giles WH et al (2004) Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factors. Ethn Dis 14(1):43–48PubMedGoogle Scholar
  45. Siegel M, Luengen M, Stock S (2013) On age-specific variations in income-related inequalities in diabetes, hypertension and obesity. Int J Public Health 58(1):33–41. doi: 10.1007/s00038-012-0368-7 PubMedCrossRefGoogle Scholar
  46. Stiglitz JE (2012) The price of inequality: how today’s divided society endangers our future. W.W. Norton and Company, New York CityGoogle Scholar
  47. Stults-Kolehmainen MA, Sinha R (2014) The effects of stress on physical activity and exercise. Sports Med 44(1):81–121. doi: 10.1007/s40279-013-0090-5 PubMedCentralPubMedCrossRefGoogle Scholar
  48. Twenge JM, Catanese KR, Baumeister RF (2002) Social exclusion causes self-defeating behavior. J Pers Soc Psychol 83(3):606–615PubMedCrossRefGoogle Scholar
  49. Wilkinson RG (1997) Socioeconomic determinants of health. Health inequalities: relative or absolute material standards? BMJ 314(7080):591–595PubMedCentralPubMedCrossRefGoogle Scholar
  50. Wilkinson RG, Pickett KE (2006) Income inequality and population health: a review and explanation of the evidence. Soc Sci Med 62(7):1768–1784. doi: 10.1016/j.socscimed.2005.08.036 PubMedCrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health 2015

Authors and Affiliations

  • Roman Pabayo
    • 1
    • 2
    Email author
  • Ichiro Kawachi
    • 2
  • Stephen E. Gilman
    • 2
    • 3
    • 4
  1. 1.Department of Community Health SciencesUniversity of Nevada, RenoRenoUSA
  2. 2.Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonUSA
  3. 3.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA
  4. 4.Department of PsychiatryMassachusetts General HospitalBostonUSA

Personalised recommendations