Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
JAMA Cardiol. 2019 Dec 1;4(12):1203-1212. doi: 10.1001/jamacardio.2019.3788.
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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
较高的收入与较低的心血管疾病（CVD）发病率相关。然而，关于收入变化与 CVD 发病风险之间的关系，研究有限。
研究家庭收入变化与 CVD 发病风险之间的关系。
设计、地点和参与者：动脉粥样硬化风险社区研究（ARIC）是一项正在进行的前瞻性队列研究，纳入了来自美国 4 个中心（密西西比州杰克逊、马里兰州华盛顿县、明尼苏达州明尼阿波利斯郊区和北卡罗来纳州福赛斯县）的 15792 名社区居住的男性和女性，他们主要为黑种人或白种人，研究于 1987 年开始。在我们的分析中，参与者的随访时间截止到 2016 年 12 月 31 日。
根据参与者在 ARIC 访问 1（1987-1989 年）和访问 3（1993-1995 年）之间的平均（SD）约 6（0.3）年期间，家庭收入下降超过 50%（收入下降）、不变/变化小于 50%（收入不变）或增加超过 50%（收入增加），对参与者进行了分类。
我们的主要结局是 ARIC 访问 3 后 CVD 的发病情况，包括心肌梗死（MI）、致命性冠心病、心力衰竭（HF）或中风，平均（SD）随访时间为 17（7）年。分析调整了社会人口统计学变量、健康行为和 CVD 生物标志物。
在 8989 名纳入的参与者中（平均[SD]入组年龄为 53[6]岁，1820 名参与者为黑人[20%]，3835 名参与者为男性[43%]），900 名参与者（10%）经历了收入下降，6284 名参与者（70%）的收入相对不变，1805 名参与者（20%）的收入增加。经过充分调整后，收入下降组发生 CVD 事件的风险明显高于收入相对不变组（风险比，1.17；95%置信区间，1.03-1.32）。收入增加组发生 CVD 事件的风险明显低于收入相对不变组（风险比，0.86；95%置信区间，0.77-0.96）。
6 年内收入下降与 17 年内随后发生 CVD 事件的风险升高相关，而 6 年内收入增加与 17 年内随后发生 CVD 事件的风险降低相关。医疗保健专业人员应该更加意识到收入变化对患者健康的影响。
