ArticleArquivos brasileiros de cardiologia2023
Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability.
Article in Arquivos brasileiros de cardiologia, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed, 2 citations in OpenAlex.
- Global trends and inequalities in hypertensive and ischemic heart disease attributable to high body mass index: A systematic analysis from 1990 to 2021 with projections to 2035.American heart journal plus : cardiology research and practice · 2025Article
- Global trends in the burden of ischemic heart disease based on the global burden of disease study 2021: the role of metabolic risk factors.BMC public health · 2025Article
- Ischemic Heart Disease and Income Level - A Thinking on Social and Structural Determinants.Arquivos brasileiros de cardiologia · 2024Article
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12 authors at 2 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundAssociation of Income Level and Ischemic Heart Disease: Potential Role of Walkability Association of ischemic heart disease (adjusted for traditional risk factors and socioeconomics variables) and income level (A), and walkability z-score (B), and association of walkability z-score and income level (C).
backgroundSocioeconomic status has been linked to ischemic heart disease (IHD). High-income neighborhoods may expose individuals to a walking-promoting built environment for daily activities (walkability). Data from the association between income and IHD is lacking in middle-income countries. It is also uncertain whether walkability mediates this association.
objectivesTo investigate whether income is associated with IHD in a middle-income country and whether neighborhood walkability mediates the income-IHD association.
methodsThis cross-sectional study evaluated 44,589 patients referred for myocardial perfusion imaging (SPECT-MPI). Income and walkability were derived from participants' residential census tract. Walkability quantitative score combined 4 variables: street connectivity, residential density, commercial density, and mixed land use. IHD was defined by abnormal myocardial perfusion during a SPECT-MPI study. We used adjusted mixed effects models to evaluate the association between income level and IHD, and we performed a mediation analysis to measure the percentage of the income-IHD association mediated by walkability. We considered p values below 0.01 as statistically significant.
resultsFrom 26,415 participants, those living in the lowest-income tertile census tract were more physically inactive (79.1% versus 75.8% versus 72.7%) when compared to higher-income tertile census tracts (p < 0.001). Income was associated with IHD (odds ratio: 0.91 [95% confidence interval: 0.87 to 0.96] for each 1,000.00 international dollars increase in income) for both men and women equally (p for interaction = 0.47). Census tracts with a higher income were associated with better walkability (p < 0.001); however, walkability did not mediate the income-IHD association (percent mediated = -0.3%).
conclusionsIncome was independently associated with higher prevalence of IHD in a middle-income country irrespective of gender. Although walkability was associated with census tract income, it did not mediate the income-IHD association.
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