Community Socioeconomic Status Is Associated With Carotid Artery Atherosclerosis in Untreated, Hypertensive Men

Abstract

Individuals of low socioeconomic status (SES) are at increased risk for cardiovascular disease relative to persons of more advantaged social position. Recent evidence suggests that community SES (variation in the material and social resources of communities) also predicts incident cardiovascular disease, and may do so independently of individual level SES. In this study we examined whether community SES is similarly associated with preclinical vascular disease, as measured by carotid artery ultrasonography. Subjects were 230 untreated hypertensive men without history of coronary heart disease, residing in and around Pittsburgh, PA (80% white, 20% African-American; mean age, 56 years). Community SES was defined by levels of income, economic disadvantage (eg, poverty, unemployment), housing costs, and educational attainment in the US Census tract of residence for each subject. A composite community SES score was calculated for each subject as the average of all extracted census measures. Individual SES was estimated from subjects' years of education and current annual income. Regression analyses accounting for traditional risk factors showed community disadvantage to be associated with greater intima-medial thickness (b = 0.02, P < .05) and plaque occurrence (odds ratio [OR] = 1.51, P < .01). The latter association persisted on multivariable adjustment for both risk factors and individual markers of social position (SES) (OR = 1.68, P < .01). Irrespective of one's own income or educational attainment, untreated hypertensive men living in poorer communities are more likely to exhibit preclinical atherosclerosis than residents of more affluent areas.