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Disparities in Mortality and Cardiovascular Events by Income and Blood Pressure Levels Among Patients With Hypertension in South Korea

Authors
 Jeong-Hun Shin  ;  Mi-Hyang Jung  ;  Chang Hee Kwon  ;  Chan Joo Lee  ;  Dae-Hee Kim  ;  Hack-Lyoung Kim  ;  Woohyeun Kim  ;  Si-Hyuck Kang  ;  Ju-Hee Lee  ;  Hyue Mee Kim  ;  In-Jeong Cho  ;  Iksung Cho  ;  Jun Hyeok Lee  ;  Dae Ryong Kang  ;  Hae-Young Lee  ;  Wook-Jin Chung  ;  Sang-Hyun Ihm  ;  Kwang Il Kim  ;  Eun Joo Cho  ;  Il-Suk Sohn  ;  Hyeon-Chang Kim  ;  Sungha Park  ;  Jinho Shin  ;  Ju Han Kim  ;  Sung Kee Ryu  ;  Seok-Min Kang  ;  Wook Bum Pyun  ;  Myeong-Chan Cho  ;  Ki-Chul Sung 
Citation
 JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol.10(7) : e018446, 2021-04 
Journal Title
JOURNAL OF THE AMERICAN HEART ASSOCIATION
Issue Date
2021-04
Keywords
blood pressure ; cardiovascular diseases ; health status disparities ; hypertension ; income ; mortality
Abstract
Background Socioeconomic status is associated with differences in risk factors of cardiovascular disease and increased risks of cardiovascular disease and mortality. However, it is unclear whether an association exists between cardiovascular disease and income, a common measure of socioeconomic status, among patients with hypertension. Methods and Results This population-based longitudinal study comprised 479 359 patients aged ≥19 years diagnosed with essential hypertension. Participants were categorized by income and blood pressure levels. Primary end point was all-cause and cardiovascular mortality and secondary end points were cardiovascular events, a composite of cardiovascular death, myocardial infarction, and stroke. Low income was significantly associated with high all-cause (hazard ratio [HR], 1.26; 95% CI, 1.23-1.29, lowest versus highest income) and cardiovascular mortality (HR, 1.31; 95% CI, 1.25-1.38) as well as cardiovascular events (HR, 1.07; 95% CI, 1.05-1.10) in patients with hypertension after adjusting for age, sex, systolic blood pressure, body mass index, smoking status, alcohol consumption, physical activity, fasting glucose, total cholesterol, and the use of aspirin or statins. In each blood pressure category, low-income levels were associated with high all-cause and cardiovascular mortality and cardiovascular events. The excess risks of all-cause and cardiovascular mortality and cardiovascular events associated with uncontrolled blood pressure were more prominent in the lowest income group. Conclusions Low income and uncontrolled blood pressure are associated with increased all-cause and cardiovascular mortality and cardiovascular events in patients with hypertension. These findings suggest that income is an important aspect of social determinants of health that has an impact on cardiovascular outcomes in the care of hypertension.
Files in This Item:
T202103639.pdf Download
DOI
10.1161/JAHA.120.018446
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Park, Sung Ha(박성하) ORCID logo https://orcid.org/0000-0001-5362-478X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184767
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