Table 4.

Adjusted Hazard Ratios for the Association Between Socioeconomic Position Across the Life Course and Incident Heart Failure, by Racial/Ethnic Group, ARIC LC-SES Study, 1987–2004^a

Race/Ethnicity and Characteristicb	Model 1		Model 2		Model 3		Model 4
	HR	95% CI	HR	95% CI	HR	95% CI	HR	95% CI
Blacks
Early-life SEPc
Low	1.39	1.00, 1.95	1.25	0.89, 1.77	1.20	0.85, 1.69	1.19	0.84, 1.69
Medium	1.11	0.78, 1.57	1.02	0.72, 1.44	0.98	0.69, 1.39	0.97	0.68, 1.38
High	1.00		1.00		1.00		1.00
Young adulthood SEPd
Low	1.63	1.20, 2.20	1.57	1.15, 2.14	1.33	0.95, 1.87	1.13	0.81, 1.57
Medium	1.48	1.02, 2.14	1.45	1.00, 2.10	1.28	0.87, 1.89	1.14	0.77, 1.68
High	1.00		1.00		1.00		1.00
Mid-to-older adulthood SEPe
Low	1.95	1.37, 2.78			1.68	1.14, 2.47	1.32	0.90, 1.96
Medium	1.62	1.15, 2.31			1.38	0.94, 2.03	1.20	0.82, 1.76
High	1.00				1.00		1.00
Heart failure risk factors
BMIf ≥25–30 vs. <25							1.69	1.06, 2.69
BMI ≥30 vs. <25							2.39	1.51, 3.78
Type 2 diabetes mellitus (yes vs. no)							2.91	2.19, 3.86
Hypertension (yes vs. no)							1.42	1.06, 1.90
Prevalent coronary heart disease (yes vs. no)							2.90	1.71, 4.92
Left ventricular hypertrophy (yes vs. no)							2.12	1.41, 3.19
Current smoker (yes vs. no)							2.06	1.53, 2.78
Current alcohol drinker (yes vs. no)							0.66	0.47, 0.93
No health insurance (yes vs. no)							1.44	1.06, 1.93
Whites
Early-life SEPc
Low	1.32	1.06, 1.64	1.20	0.96, 1.51	1.16	0.92, 1.46	1.08	0.86, 1.35
Medium	1.10	0.86, 1.39	1.05	0.82, 1.34	1.03	0.81, 1.32	0.95	0.74, 1.21
High	1.00		1.00		1.00		1.00
Young adulthood SEPd
Low	1.53	1.25, 1.87	1.47	1.20, 1.81	1.33	1.07, 1.64	1.14	0.91, 1.42
Medium	1.12	0.89, 1.41	1.09	0.86, 1.39	1.05	0.83, 1.34	0.97	0.76, 1.23
High	1.00		1.00		1.00		1.00
Mid-to-older adulthood SEPe
Low	1.77	1.43, 2.18			1.60	1.28, 1.99	1.39	1.11, 1.75
Medium	1.21	0.94, 1.55			1.10	0.85, 1.42	1.09	0.85, 1.41
High	1.00				1.00		1.00
Heart failure risk factors
BMI ≥25–30 vs. <25							1.57	1.24, 1.98
BMI ≥30 vs. 25							2.89	2.27, 3.68
Type 2 diabetes mellitus (yes vs. no)							2.14	1.71, 2.67
Hypertension (yes vs. no)							1.61	1.34, 1.92
Prevalent coronary heart disease (yes vs. no)							3.50	2.71, 4.53
Left ventricular hypertrophy (yes vs. no)							2.34	1.37, 4.01
Current smoker (yes vs. no)							2.34	1.93, 2.84
Current alcohol drinker (yes vs. no)							0.89	0.74, 1.07
No health insurance (yes vs. no)							0.99	0.76, 1.16

Abbreviations: ARIC, Atherosclerosis Risk in Communities; BMI, body mass index; CI, confidence interval; HR, hazard ratio; LC-SES, Life Course Socioeconomic Status, Social Context, and Cardiovascular Disease; SEP, socioeconomic position.

^aIn model 1, results for each life epoch were adjusted for age, gender, and study center. In model 2, results were adjusted for all variables in model 1 + young adulthood SEP. In model 3, results were adjusted for all variables in model 2 + mid-to-older adulthood SEP. In model 4, results were adjusted for all variables in model 3 + heart failure risk factors.

^bEach life epoch SEP measure was generated by summing the individual SEP factors within each life epoch and dividing the total at the 25th and 75th percentiles. “Low,” “medium,” and “high” represent the most disadvantaged to the least disadvantaged, respectively.

^cEarly-life SEP was composed of parents’ educational level, class, and home ownership status when the participant was 10 years of age. Data on individual-level SEP indicators for early life and young adulthood were collected during the LC-SES Study (2001).

^dYoung adulthood SEP consisted of the educational level, class, and home ownership status of the participant at age 30 years. Data on individual-level SEP indicators for young adulthood were collected during the LC-SES Study (2001).

^eMid-to-older adulthood SEP was a composite of the participant's income, occupation, and home ownership status at ARIC baseline (1987–1989).

^fWeight (kg)/height (m)².