US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings
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To examine prospectively the association between US state income inequality and incidence of heart attack.
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.
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.
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.
KeywordsIncome inequality Coronary heart disease Social determinants of health Multilevel modeling Longitudinal analysis Population-based study
This work was supported by NIH-grant number MH087544. RP was a Canadian Institutes of Health Research postdoctoral fellowship recipient #234617.
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