“Lower education may not matter if a person is able to maintain a high income in later years,” said Ali Ahmed, M.D., professor of medicine in the Division of Gerontology, Geriatrics and Palliative Care, and senior investigator of the first study to link low income with an increased risk of heart failure.
Researchers reviewed National Heart, Lung, and Blood Institute records spanning 13 years for 5,153 Medicare patients without heart failure who lived independently.
According to the American Heart Association, about 20 percent of Americans ages 49 and older are at risk of developing heart failure, but the records analysis revealed these distinctions:
· Patients with low education and low income were 29 percent more likely to have heart failure.
· Patients with high education and low income were 23 percent more likely to develop heart failure compared with 17 percent of those with low education and high income.
· Less education increased the chances of heart failure by only 1 percent in the high-income group.
Researchers were surprised by the influence of income on heart-failure risk among a population in which everyone has health insurance. Medicare often is an equalizer, benefitting both poor and the non-poor alike, but low-income patients still may be unable to pay out-of-pocket costs for health care it provides, Ahmed says.
“They may have to choose between their drugs and their groceries,” said Ahmed, director of the UAB Geriatric Heart Failure Clinic and a physician at the Birmingham VA Medical Center. “Or the out-of-pocket expenses might adversely affect how often they go see their doctor.”
Income also affects access to healthy foods and safe, affordable places for physical activity, Ahmed says, and study findings express the need to explore low-cost ways to promote healthy lifestyles, particularly access to good nutrition and exercise.
More research is needed to identify specific factors that increase the risk of heart failure for people with low-income so that effective strategies can be initiated, Ahmed says.
For this analysis, patients were grouped by education and income level; education below college level and household income less than $25,000 were defined as low.
Researchers accounted for age, gender, race and known risk factors such as diabetes, high blood pressure, smoking, overweight and having a history of coronary artery disease, stroke or peripheral artery disease.
Patients reported their income and education, and it is unknown whether education quality may have affected heart-failure risk, Ahmed said.
Co-authors include Amiya A. Ahmed; Yan Zhang, M.S., M.S.P.H.; Robert C. Bourge, M.D.; Meredith L. Kilgore, Ph.D., R.N.; Beverly Williams, Ph.D.; Patricia Sawyer, Ph.D.; Inmaculada B. Aban, Ph.D.; and Gregg C. Fonarow, M.D.