abstract: 'Background: For women, who are more likely to live in poverty, defining

  the clinical and economic impact of socioeconomic factors may aid in

  defining redistributive policies to improve healthcare quality.

  Methods. The NIH-NHLBI-sponsored Women''s Ischemia Syndrome Evaluation

  (WISE) enrolled 819 women referred for clinically indicated coronary

  angiography. This study''s primary end point was to evaluate the

  independent contribution of socioeconomic factors on the estimation of

  time to cardiovascular death or myocardial infarction (MI) (n = 79)

  using Cox proportional hazards models. Secondary aims included an

  examination of cardiovascular costs and quality of life within

  socioeconomic subsets of women.

  Results: In univariable models, socioeconomic factors associated with an

  elevated risk of cardiovascular death or MI included an annual household

  income <\$20,000 (p = 0.0001), <9th grade education (p = 0.002), being

  African American, Hispanic, Asian, or American Indian (p = 0.016), on

  Medicaid, Medicare, or other public health insurance (p < 0.0001),

  unmarried (p = 0.001.), unemployed or employed part-time (p < 0.0001),

  and working in a service job (p = 0.003). Of these socioeconomic

  factors, income (p = 0.006) remained a significant predictor of

  cardiovascular death or MI in risk-adjusted models that controlled for

  angiographic coronary disease, chest pain symptoms, and cardiac risk

  factors. Low-income women, with an annual household income <\$20,000,

  were more often uninsured or on public insurance (p < 0.0001) yet had

  the highest 5-year hospitalization and drug treatment costs (p <

  0.0001). Only 17\% of low-income women had prescription drug coverage

  (vs. >= 50\% of higher-income households, p < 0.0001), and 64\% required

  >= 2 anti-ischemic medications during follow-up (compared with 45\% of

  those earning >=\$50,000, p < 0.0001).

  Conclusions: Economic disadvantage prominently affects cardiovascular

  disease outcomes for women with chest pain symptoms. These results

  further support a profound intertwining between poverty and poor health.

  Cardiovascular disease management strategies should focus on policies

  that track unmet healthcare needs and worsening clinical status for

  low-income women.'
affiliation: 'Shaw, LJ (Corresponding Author), Emory Univ, Sch Med, Dept Med, Div
  Cardiol,Emory Program Cardiovasc Outcome Res, Suite 1 North,1256 Briarcliff Rd NE,
  Atlanta, GA 30306 USA.

  Shaw, Leslee J., Emory Univ, Sch Med, Dept Med, Div Cardiol,Emory Program Cardiovasc
  Outcome Res, Atlanta, GA 30306 USA.

  Merz, C. Noel Bairey, Cedars Sinai Med Ctr, Cedars Sinai Res Inst, Los Angeles,
  CA 90048 USA.

  Bittner, Vera; Rogers, William J., Univ Alabama, Dept Med, Div Cardiovasc Dis, Birmingham,
  AL 35294 USA.

  Kip, Kevin; Johnson, B. Delia; Kelsey, Sheryl F.; Olson, Marian, Univ Pittsburgh,
  Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA USA.

  Reis, Steven E., Univ Pittsburgh, Med Ctr, Cardiovasc Inst, Pittsburgh, PA USA.

  Mankad, Sunil, Allegheny Univ Hlth Sci, Dept Med, Div Cardiol, Pittsburgh, PA USA.

  Sharaf, Barry L., Rhode Isl Hosp, Div Cardiol, Providence, RI USA.

  Pohost, Gerald M., Univ So Calif, Div Cardiol, Los Angeles, CA USA.

  Sopko, George, NHLBI, NIH, Bethesda, MD 20892 USA.

  Pepine, Carl J., Univ Florida, Dept Med, Div Cardiol, Gainesville, FL USA.'
author: Shaw, Leslee J. and Merz, C. Noel Bairey and Bittner, Vera and Kip, Kevin
  and Johnson, B. Delia and Reis, Steven E. and Kelsey, Sheryl F. and Olson, Marian
  and Mankad, Sunil and Sharaf, Barry L. and Rogers, William J. and Pohost, Gerald
  M. and Sopko, George and Pepine, Carl J. and Investigators, WISE
author-email: leslee.shaw@emory.edu
author_list:
- family: Shaw
  given: Leslee J.
- family: Merz
  given: C. Noel Bairey
- family: Bittner
  given: Vera
- family: Kip
  given: Kevin
- family: Johnson
  given: B. Delia
- family: Reis
  given: Steven E.
- family: Kelsey
  given: Sheryl F.
- family: Olson
  given: Marian
- family: Mankad
  given: Sunil
- family: Sharaf
  given: Barry L.
- family: Rogers
  given: William J.
- family: Pohost
  given: Gerald M.
- family: Sopko
  given: George
- family: Pepine
  given: Carl J.
- family: Investigators
  given: WISE
da: '2023-09-28'
doi: 10.1089/jwh.2007.0596
files: []
issn: 1540-9996
journal: JOURNAL OF WOMENS HEALTH
keywords-plus: 'CORONARY-ARTERY DISEASE; FUNCTIONAL-CAPACITY; ETHNIC-DIFFERENCES;

  RISK-FACTORS; SOCIAL-CLASS; CHEST PAIN; ATHEROSCLEROSIS; INEQUALITIES;

  MORTALITY; POSITION'
language: English
month: SEP
number: '7'
number-of-cited-references: '38'
orcid-numbers: 'Bittner, Vera/0000-0001-9456-850X

  Reis, Steven/0000-0001-8023-0102'
pages: 1081-1092
papis_id: e3ada099da419ebd7d0a498382be0ab2
ref: Shaw2008importancesocioecono
researcherid-numbers: 'Reis, Steven E/J-3957-2014

  Kip, Kevin/HOH-9165-2023

  '
times-cited: '34'
title: Importance of socioeconomic status as a predictor of cardiovascular outcome
  and costs of care in women with suspected myocardial ischemia. Results from the
  National Institutes of Health, National Heart, Lung and Blood Institute-sponsored
  Women's Ischemia Syndrome Evaluation (WISE)
type: Article
unique-id: WOS:000259639200005
usage-count-last-180-days: '0'
usage-count-since-2013: '12'
volume: '17'
web-of-science-categories: 'Public, Environmental \& Occupational Health; Medicine,
  General \&

  Internal; Obstetrics \& Gynecology; Women''s Studies'
year: '2008'