Rabi Doreen M, Edwards Alun L, Svenson Lawrence W, Graham Michelle M, Knudtson Merril L, Ghali William A
Department of Medicine, University of Calgary, Calgary Canada.
Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):48-53. doi: 10.1161/CIRCOUTCOMES.108.840611. Epub 2009 Dec 29.
Low income is associated with adverse cardiovascular outcomes. Diabetes is more prevalent among low income groups, and low income patients with diabetes have been shown to have a greater burden of cardiovascular risk factors and worse cardiovascular outcomes. The objective of this study was to determine whether income status was associated with burden of coronary atherosclerosis in patients with diabetes.
All patients with diabetes presenting for cardiac catheterization between January 1, 2000, and December 31, 2002, in Calgary, Canada, were identified through the use of the Alberta Provincial Project for Assessing Outcomes in Coronary Heart Disease (APPROACH) database. This clinical database was merged with Canadian 2001 Census data on median household income per dissemination area using patient postal code data, and income quintiles were derived. Clinical profiles, severity of coronary atherosclerosis, and myocardial jeopardy were compared across income quintiles. Mean scores for severity and jeopardy were compared across income quintiles using analysis of variance. Multivariate linear regression was used to control for baseline differences across income groups. A total of 4596 patients were eligible for inclusion in this study. Clinical profiles differed significantly across income quintiles, with the highest income quintile being younger (P<0.0005), more likely to be male (P=0.029), and having a lower prevalence of smoking (P=0. 039). Low income groups were more likely to report a history of myocardial infarction (P<0.0005) or congestive heart failure (P<0.0005). The highest income groups has significantly less coronary atherosclerosis as measured by the weighted Duke index (6.67 versus 7.38, P<0.002), but there were no differences in lesion severity as measured by the Duke severity scale (2.31 versus 2.41, P=0.334). High income patients has significantly less myocardial jeopardy compared with the lowest income group as measured by the Duke and APPROACH scores (36.44 versus 46.23, P=0.0187, and 39.96 versus 45.36, P=0.0182, respectively). These differences remained significant even after controlling for baseline clinical differences in cardiovascular risk factor burden.
Low income is associated with a greater degree of atherosclerosis and greater myocardial jeopardy in patients with diabetes. More needs to be done to reduce cardiovascular risk factor burden in this vulnerable population.
低收入与不良心血管结局相关。糖尿病在低收入群体中更为普遍，且糖尿病低收入患者已被证明具有更大的心血管危险因素负担和更差的心血管结局。本研究的目的是确定收入状况是否与糖尿病患者的冠状动脉粥样硬化负担相关。
通过使用艾伯塔省冠心病结局评估项目（APPROACH）数据库，确定了2000年1月1日至2002年12月31日在加拿大卡尔加里进行心脏导管插入术的所有糖尿病患者。该临床数据库与加拿大2001年人口普查数据合并，根据患者邮政编码数据得出每个传播区域的家庭收入中位数，并划分出收入五分位数。比较了各收入五分位数的临床特征、冠状动脉粥样硬化严重程度和心肌危险程度。使用方差分析比较各收入五分位数的严重程度和危险程度的平均得分。采用多变量线性回归来控制收入组之间的基线差异。共有4596名患者符合本研究的纳入标准。各收入五分位数的临床特征存在显著差异，收入最高的五分位数人群更年轻（P<0.0005），男性比例更高（P=0.029），吸烟率更低（P=0.039）。低收入组更有可能报告有心肌梗死病史（P<0.0005）或充血性心力衰竭病史（P<0.0005）。通过加权杜克指数测量，收入最高的组冠状动脉粥样硬化明显更少（6.67对7.38，P<0.002），但根据杜克严重程度量表测量，病变严重程度没有差异（2.31对2.41，P=0.334）。根据杜克评分和APPROACH评分测量，高收入患者与收入最低的组相比，心肌危险明显更低（分别为36.44对46.23，P=0.0187；39.96对45.36，P=0.0182）。即使在控制了心血管危险因素负担的基线临床差异后，这些差异仍然显著。
低收入与糖尿病患者更高程度的动脉粥样硬化和更大的心肌危险相关。需要采取更多措施来减轻这一弱势群体的心血管危险因素负担。
