Table 4.
Longitudinal adjusted associations between Income Inequality and risk for heart attack, weight status, anxiety, smoking, and hypertension (new cases) among US adults participating in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 34,445) (USA, 2004 and 2005)
| Heart attack |
Heart attack confirmed |
Overweight |
Obese class I |
Obese class II |
||||||
|---|---|---|---|---|---|---|---|---|---|---|
| OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | |
| State-level characteristics | ||||||||||
| Gini quartile | ||||||||||
| 1st (ref) | OR | OR | 1.00 | 1.00 | 1.00 | |||||
| 2nd | 1.67 | (1.13, 2.47) | 1.68 | (1.09, 2.59) | 1.01 | (0.84, 1.21) | 1.02 | (0.79, 1.32) | 1.29 | (1.07, 1.55) |
| 3rd | 1.68 | (1.18, 2.40) | 1.50 | (1.01, 2.23) | 1.04 | (0.85, 1.29) | 0.94 | (0.70, 1.25) | 1.22 | (0.96, 1.55) |
| 4th | 1.95 | (1.20, 3.17) | 1.77 | (1.06, 2.95) | 1.02 | (0.78, 1.340 | 1.10 | (0.78, 1.56) | 1.28 | (0.99, 1.65) |
| State median income | 0.84 | (0.67, 1.05) | 0.81 | (0.63, 1.04) | 1.03 | (0.90, 1.18) | 0.99 | (0.83, 1.19) | 1.08 | (0.94, 1.25) |
| Proportion black | 1.01 | (0.75, 1.36) | 1.08 | (0.81, 1.45) | 1.05 | (0.93, 1.19) | 0.96 | (0.84, 1.09) | 0.86 | (0.75, 0.99) |
| Proportion in poverty | 0.86 | (0.70, 1.05) | 0.85 | (0.69, 1.05) | 0.95 | (0.83, 1.10) | 0.99 | (0.81, 1.21) | 1.18 | (1.01, 1.37) |
| State population size | 0.92 | (0.82, 1.03) | 0.95 | (0.85, 1.07) | 1.03 | (0.96, 1.11) | 0.94 | (0.88, 1.02) | 0.95 | (0.88, 1.03) |
| Census division (ref: New England) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||
| Middle Atlantic | 0.94 | (0.58, 1.52) | 1.08 | (0.70, 1.68) | 1.07 | (0.81, 1.40) | 1.15 | (0.78, 1.68) | 1.41 | (0.90, 2.20) |
| East North Central | 1.00 | (0.61, 1.63) | 1.08 | (0.69, 1.70) | 1.11 | (0.85, 1.460 | 1.28 | (0.87, 1.88) | 1.61 | (1.00, 2.58) |
| West North Central | 1.31 | (0.75, 2.30) | 1.43 | (0.81, 2.51) | 0.98 | (0.77, 1.24) | 1.07 | (0.70, 1.62) | 1.43 | (0.91, 2.24) |
| South Atlantic | 0.79 | (0.41, 1.53) | 0.83 | (0.44, 1.58) | 1.03 | (0.77, 1.39) | 1.37 | (0.87, 2.13) | 1.37 | (0.84, 2.23) |
| East Coast Central | 0.49 | (0.26, 0.92) | 0.58 | (0.32, 1.05) | 1.48 | (0.96, 2.29) | 1.27 | (0.76, 2.13) | 1.07 | (0.64, 1.78) |
| West South Central | 0.91 | (0.52, 1.60) | 0.97 | (0.56, 1.71) | 1.06 | (0.78, 1.46) | 1.40 | (0.87, 2.26) | 1.18 | (0.72, 1.94) |
| Mountain | 1.07 | (0.63, 1.81) | 1.34 | (0.86, 2.08) | 0.96 | (0.74, 1.23) | 1.16 | (0.71, 1.89) | 0.94 | (0.57, 1.55) |
| Pacific | 1.43 | (0.90, 2.27) | 1.50 | (1.01, 2.22) | 1.06 | (0.81, 1.39) | 1.29 | (0.83, 1.99) | 1.17 | (0.75, 1.82) |
| Individual-level characteristics | ||||||||||
| Sex | ||||||||||
| Male | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||
| Female | 0.58 | (0.45, 0.74) | 0.57 | (0.44, 0.75) | 0.70 | (0.63, 0.78) | 1.19 | (1.07, 1.34) | 1.41 | (1.25, 1.59) |
| Age, years (ref: ≥80) | ||||||||||
| 18–29 | 0.04 | (0.02, 0.07) | 0.02 | (0.01, 0.04) | 2.47 | (1.77, 3.45) | 3.18 | (2.42,4.17) | 4.96 | (3.02, 8.14) |
| 30–39 | 0.11 | (0.06, 0.22) | 0.11 | (0.06, 0.22) | 2.58 | (1.87, 3.57) | 3.86 | (3.00, 4.96) | 5.10 | (3.12, 8.34) |
| 40–49 | 0.27 | (0.17, 0.44) | 0.29 | (0.18, 0.46) | 2.26 | (1.61, 3.17) | 3.46 | (2.65, 4.52) | 5.35 | (3.21, 8.90) |
| 50–59 | 0.53 | (0.33, 0.83) | 0.50 | (0.32, 0.78) | 2.14 | (1.49, 3.09) | 3.75 | (2.90, 4.85) | 6.33 | (3.98, 10.07) |
| 60–69 | 0.63 | (0.40, 0.98) | 0.64 | (0.41, 0.99) | 1.76 | (1.23, 2.52) | 3.98 | (2.31, 3.84) | 3.92 | (2.36, 6.51) |
| 70–79 | 0.90 | (0.59, 1.37) | 0.90 | (0.58, 1.39) | 1.76 | (1.34, 2.31) | 2.34 | (1.32, 4.17) | ||
| Racial background | ||||||||||
| White | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||
| Black | 1.33 | (0.91, 1.96) | 1.23 | (0.83, 1.84) | 1.35 | (1.19, 1.55) | 1.54 | (1.32, 1.79) | 1.82 | (1.49, 2.22) |
| Native | 1.51 | (0.69, 3.33) | 1.63 | (0.75, 3.53) | 1.34 | (0.91, 1.97) | 1.61 | (1.14, 2.27) | 1.58 | (1.02, 2.44) |
| Asian | 0.59 | (0.25, 1.38) | 0.49 | (0.19, 1.28) | 0.64 | (0.54, 0.77) | 0.43 | (0.32, 0.58) | 0.31 | (0.18, 0.51) |
| Hispanic | 1.21 | (0.80, 1.84) | 1.13 | (0.81, 1.56) | 1.74 | (1.52, 2.00) | 1.28 | (1.07, 1.54) | 1.26 | (0.99, 1.60) |
| Household income | ||||||||||
| Low (ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||
| Moderate | 0.72 | (0.54, 0.95) | 0.71 | (0.53, 0.96) | 1.07 | (0.91, 1.26) | 1.05 | (0.93, 1.19) | 1.16 | (0.94, 1.42) |
| High | 0.32 | (0.21, 0.49) | 0.3 | (0.19, 0.50) | 1.01 | (0.83, 1.23) | 1.09 | (0.92, 1.28) | 0.93 | (0.75, 1.15) |
| Education | ||||||||||
| Less than high school | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||
| High school | 0.85 | (0.63, 1.14) | 0.85 | (0.62, 1.18) | 1.06 | (0.89, 1.27) | 0.98 | (0.83, 1.16) | 0.84 | (0.69, 1.04) |
| Post-secondary | 0.80 | (0.53, 1.21) | 0.80 | (0.52, 1.24) | 0.90 | (0.73, 1.12) | 0.81 | (0.68, 0.97) | 0.71 | (0.58, 0.87) |
| Graduate school | 0.59 | (0.35, 1.02) | 0.58 | (0.34, 0.99) | 0.71 | (0.53, 0.96) | 0.48 | (0.40, 0.57) | 0.46 | (0.36, 0.58) |
| Marital status | ||||||||||
| Couple | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||
| Single | 1.05 | (0.81, 1.36) | 1.01 | (0.78, 1.31) | 0.97 | (0.89, 1.07) | 1.05 | (0.94, 1.19) | 1.17 | (1.00, 1.36) |
| Setting | ||||||||||
| Rural | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||
| Suburban | 0.89 | (0.62, 1.28) | 0.83 | (0.57, 1.20) | 1.00 | (0.84, 1.22) | 1.11 | (0.97, 1.28) | 0.9 | (0.74, 1.10) |
| Urban | 1.01 | (0.75, 1.36) | 1.00 | (0.73, 1.37) | 1.00 | (0.84, 1.18) | 1.03 | (0.88, 1.21) | 0.9 | (0.77, 1.05) |
| Obese class III |
Anxiety |
Smoker |
Hypertension |
|||||
|---|---|---|---|---|---|---|---|---|
| OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | |
| State-level characteristics | ||||||||
| Gini quartile | ||||||||
| 1st (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| 2nd | 1.61 | (1.16, 2.23) | 1.01 | (0.79, 1.28) | 1.04 | (0.91, 1.19) | 1.07 | (0.87, 1.33) |
| 3rd | 1.55 | (1.08, 2.22) | 1.19 | (0.88, 1.62) | 1.11 | (0.96, 1.28) | 1.03 | (0.83, 1.29) |
| 4th | 1.18 | (0.74, 1.89) | 0.77 | (0.54, 1.11) | 1.02 | (0.88, 1.19) | 1.17 | (0.92, 1.50) |
| State median income | 1.25 | (0.99, 1.58) | 1.22 | (1.02, 1.45) | 1.07 | (0.98, 1.17) | 1.02 | (0.91,1.15) |
| Proportion black | 0.89 | (0.72, 1.12) | 0.83 | (0.71, 0.98) | 0.9 | (0.83, 0.97) | 0.93 | (0.81,1.05) |
| Proportion in poverty | 1.22 | (0.95, 1.56) | 1.11 | (0.90, 1.37) | 1.14 | (1.05, 1.23) | 0.98 | (0.85,1.13) |
| State population size | 0.94 | (0.84, 1.06) | 1.00 | (0.90, 1.10) | 0.94 | (0.90, 0.98) | 1.00 | (0.94,1.05) |
| Census division (ref: New England) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Middle Atlantic | 1.1 | (0.71, 1.72) | 0.98 | (0.65, 1.48) | 1.23 | (0.96, 1.57) | 1.26 | (0.92,1.73) |
| East North Central | 1.28 | (0.80, 2.04) | 1.35 | (0.91, 2.01) | 1.38 | (1.13, 1.69) | 1.33 | (0.98,1.82) |
| West North Central | 1.12 | (0.68, 1.85) | 0.90 | (0.61, 1.33) | 1.27 | (1.02, 1.59) | 1.15 | (0.81,1.65) |
| South Atlantic | 1.42 | (0.82, 2.47) | 1.66 | (1.08, 2.54) | 1.38 | (1.10, 1.73) | 1.66 | (1.18,2.36) |
| East Coast Central | 1.4 | (0.76, 2.56) | 1.86 | (1.13, 3.09) | 1.37 | (1.09, 1.73) | 1.74 | (1.27,2.39) |
| West South Central | 1.47 | (0.91, 2.37) | 1.65 | (1.08, 2.53) | 1.28 | (1.01, 1.63) | 1.52 | (1.10,2.10) |
| Mountain | 0.71 | (0.43, 1.18) | 1.02 | (0.69, 1.50) | 1.02 | (0.83, 1.25) | 1.20 | (0.80,1.81) |
| Pacific | 1.12 | (0.71, 1.77) | 1.16 | (0.70, 1.91) | 0.93 | (0.76, 1.15) | 1.35 | (0.99,1.85) |
| Individual-level characteristics | ||||||||
| Sex | ||||||||
| Male | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Female | 1.59 | (1.37, 1.85) | 2.26 | (1.98, 2.58) | 0.55 | (0.51, 0.60) | 0.99 | (0.89, 1.10) |
| Age, years (ref: ≥80) | ||||||||
| 18–29 | 3.64 | (1.28, 10.38) | 2.96 | (1.74, 5.02) | 15.15 | (11.10, 20.68) | 0.11 | (0.08, 0.16) |
| 30–39 | 3.80 | (1.32, 10.95) | 3.41 | (1.95, 5.98) | 15.95 | (11.80, 21.55) | 0.22 | (0.17, 0.30) |
| 40–49 | 3.7 | (1.29, 10.65) | 3.59 | (2.14, 6.01) | 16.78 | (12.51, 22.49) | 0.38 | (0.29, 0.49) |
| 50–59 | 4.67 | (1.60, 13.66) | 2.90 | (1.69, 4.98) | 13.16 | (9.85, 17.58) | 0.72 | (0.56, 0.93) |
| 60–69 | 2.27 | (0.78, 6.61) | 1.37 | (0.83, 2.27) | 7.88 | (5.90, 10.53) | 0.86 | (0.68, 1.09) |
| 70–79 | 1.49 | (0.57, 3.90) | 1.07 | (0.57, 2.02) | 3.06 | (2.23, 4.20) | 1.08 | (0.84, 1.39) |
| Racial background | ||||||||
| White | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Black | 1.50 | (1.26, 1.80) | 0.70 | (0.58, 0.83) | 0.63 | (0.54, 0.73) | 1.72 | (1.51, 1.96) |
| Native | 2.09 | (1.41, 3.10) | 1.18 | (0.80, 1.72) | 1.54 | (1.18, 2.02) | 1.12 | (0.73, 1.70) |
| Asian | 0.53 | (0.29, 0.98) | 0.67 | (0.40, 1.12) | 0.48 | (0.38, 0.59) | 1.18 | (0.93, 1.49) |
| Hispanic | 1.11 | (0.80, 1.56) | 0.62 | (0.47, 0.81) | 0.39 | (0.32, 0.47) | 0.90 | (0.78, 1.03) |
| Household income | ||||||||
| Low (ref) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Moderate | 1.04 | (0.81, 1.33) | 0.76 | (0.62, 0.92) | 0.86 | (0.80, 0.93) | 0.92 | (0.82, 1.03) |
| High | 0.84 | (0.54, 1.31) | 0.59 | (0.45, 0.79) | 0.7 | (0.63, 0.77) | 0.86 | (0.77, 0.97) |
| Education | ||||||||
| Less than high school | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| High school | 0.79 | (0.61, 1.02) | 0.76 | (0.61, 0.95) | 0.75 | (0.66, 0.86) | 0.96 | (0.85, 1.07) |
| Post-secondary | 0.58 | (0.42, 0.79) | 0.85 | (0.69, 1.04) | 0.48 | (0.43, 0.55) | 0.87 | (0.75, 1.01) |
| Graduate school | 0.45 | (0.30, 0.67) | 0.80 | (0.60, 1.06) | 0.21 | (0.18, 0.26) | 0.70 | (0.57, 0.86) |
| Marital status | ||||||||
| Couple | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Single | 1.23 | (1.02, 1.49) | 1.01 | (0.87, 1.16) | 1.52 | (1.42, 1.64) | 1.06 | (0.95, 1.17) |
| Setting | ||||||||
| Rural | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Suburban | 0.92 | (0.69, 1.23) | 1.24 | (1.01, 1.51) | 0.84 | (0.77, 0.90) | 0.93 | (0.83, 1.05) |
| Urban | 0.85 | (0.64, 1.14) | 1.34 | (1.07, 1.66) | 0.86 | (0.79, 0.94) | 0.86 | (0.76, 0.98) |
Number of confirmed heart attacks (new cases) at follow-up by Gini Quartile Group—quartile 1: 26, quartile 2: 63, quartile 3: 76, quartile 4: 118