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Socioeconomic status associated with peripheral artery disease risk

In a new study, researchers have found higher rates of peripheral artery disease in individuals with low income and lower attained education levels in the United States

Brigham and Women's Hospital


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Previous research has established a link between lower socioeconomic status and an increased risk of cardiovascular disease. In a new study led by Brigham and Women's Hospital (BWH), researchers have found that there are also higher rates of peripheral artery disease (PAD) in individuals with low income and lower attained education levels in the United States.

These findings are published online ahead of print in Circulation: Cardiovascular Quality and Outcomes.

"Our finding highlights the need to focus on education and advocacy efforts for these at-risk populations," said Reena Pande, MD, MSc, co-author of the publication and an associate physician in the Cardiovascular Division at BWH.

PAD, a circulatory problem in which narrowed arteries reduce blood flow to limbs, most commonly to the legs, causes leg pain and is often an indicator of more wide-spread artherosclerosis. Individuals with PAD are also at increased risk of having heart disease and blockages in the blood flow the brain. PAD can be treated with lifestyle modifications such as exercising, eating a healthy diet and quitting tobacco, and some individuals may require a procedure to restore blood flow to the limbs.

Researchers analyzed data from the National Health and Nutrition Examination Survey from 1999 to 2004. PAD was defined using a standard of care measurement, an ankle-brachial index of ≤0.90. Measures of socioeconomic status included poverty-income ratio, a ratio of self-reported income relative to the poverty line, and attained education level.

Of 6,791 eligible participants, researchers found that PAD prevalence was significantly higher in individuals with low income and lower education. Individuals in the lowest of the 6 poverty- income ratio categories had more than a 2-fold increased odds of PAD compared with those in the highest poverty-income ratio category, an association that was still significant after accounting for other risk factors. Lower attained education level was also associated with higher PAD prevalence, but after adjusting for other factors, this association was no longer significant.

Researchers note that education and income are only two of many potential measures of socioeconomic status and that other measures may also have an effect on overall health, including a network of family and friends and access to resources and opportunities that may impact health outcomes.

"We need dedicated approaches to PAD awareness efforts, research endeavors, and treatment strategies that focus on those individuals of low socioeconomic strata who may be most likely to be affected by PAD," Pande said. Specifically, we need to target awareness efforts to the subpopulations that have the greatest gaps in awareness and at the same time are at higher risk of developing PAD. In the evaluation and implementation of new therapies or treatment strategies, we must consider that not only may differences in outcomes arise from socioeconomic differences, but we must also develop strategies that facilitate access to these beneficial treatments to reach all segments of the population equally."


Dr Pande has received support from a Research Career Development Award (K12 HL083786) from the National, Heart, Lung Blood Institute and is the recipient of a Scientist Development Grant (10SDG4200060) from the American Heart Association. Dr Creager is the Simon C. Fireman Scholar in Cardiovascular Medicine at Brigham and Women's Hospital.

Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 3.5 million annual patient visits, is the largest birthing center in Massachusetts and employs nearly 15,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Brigham Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 1,000 physician-investigators and renowned biomedical scientists and faculty supported by nearly $650 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH continually pushes the boundaries of medicine, including building on its legacy in transplantation by performing a partial face transplant in 2009 and the nation's first full face transplant in 2011. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information, resources and to follow us on social media, please visit BWH's online newsroom.

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