Journal article
Pathways From Socioeconomic Factors to Major Cardiovascular Events Among Postmenopausal Veteran and Nonveteran Women: Findings From the Women's Health Initiative
Journal of the American Heart Association, Vol.13(24), e037253
12/17/2024
DOI: 10.1161/JAHA.124.037253
PMCID: PMC11935538
PMID: 39673348
Abstract
Cardiovascular disease (CVD) remains a leading cause of death for women in the United States, with veterans being at potentially higher risk than their nonveteran counterparts due to accelerated aging and distinct biopsychosocial mechanisms. We examined pathways between selected indicators of socioeconomic status (SES) such as education, occupation, household income, and neighborhood SES and major CVD events through lifestyle and health characteristics among veteran and nonveteran postmenopausal women.
A total of 121 286 study-eligible WHI (Women's Health Initiative) participants (3091 veterans and 118 195 nonveterans) were prospectively followed for an average of 17 years, during which 16 108 major CVD events were documented. Using generalized structural equations modeling coupled with survival analysis techniques, we estimated the effects of SES on major CVD events through smoking, body mass index, comorbidities, cardiometabolic risk factors, and self-rated health, controlling for WHI component, region, age, race, ethnicity, marital status, and health care provider access. Among veterans, SES characteristics were indirectly related to major CVD events through body mass index, comorbidities, cardiometabolic risk factors, and self-rated health. Among nonveterans, lower education (β= 0.2,
<0.0001), household income (β=+0.4,
<0.0001), and neighborhood SES (β=+0.2,
<0.0001) were positively related to major CVD events, and these relationships were partly mediated by body mass index, comorbidities, cardiometabolic risk factors, and self-rated health. Smoking played a mediating role only among nonveterans.
Nonveteran postmenopausal women exhibit more complex pathways between SES and major CVD events than their veteran counterparts, informing the design, conduct, and evaluation of preventive strategies targeting CVD by veteran status.
Details
- Title: Subtitle
- Pathways From Socioeconomic Factors to Major Cardiovascular Events Among Postmenopausal Veteran and Nonveteran Women: Findings From the Women's Health Initiative
- Creators
- Hind A Beydoun - The University of Texas Health Science Center at HoustonMay A Beydoun - National Institute on AgingRebecca L Kinney - University of Massachusetts Chan Medical SchoolSimin Liu - Brown UniversityRona Yu - Uniformed Services University of the Health SciencesMatthew Allison - University of California San DiegoRobert B Wallace - University of IowaQian Xiao - The University of Texas Health Science Center at HoustonLongjian Liu - Drexel UniversityPhilippe Gradidge - University of the WitwatersrandSu Yon Jung - University of California, Los AngelesHilary A Tindle - Vanderbilt UniversityShawna Follis - Stanford UniversityRobert Brunner - University of Nevada, RenoJack Tsai - Yale School of Medicine
- Resource Type
- Journal article
- Publication Details
- Journal of the American Heart Association, Vol.13(24), e037253
- DOI
- 10.1161/JAHA.124.037253
- PMID
- 39673348
- PMCID
- PMC11935538
- NLM abbreviation
- J Am Heart Assoc
- ISSN
- 2047-9980
- eISSN
- 2047-9980
- Publisher
- American Heart Association
- Grant note
- National Heart, Lung, and Blood Institute, National Institutes of HealthIntramural Research Program of the National Institute on Aging in Baltimore, MarylandDepartment of Veterans Affairs
The article was supported in part by the Intramural Research Program of the National Institute on Aging in Baltimore, Maryland. The views expressed in this paper are those of the authors and do not reflect the official policy or position of the Department of the Navy, the Uniformed Services University of the Health Sciences, the Department of Defense, the Department of Veterans Affairs, the National Institutes of Health, or the US government. The authors thank the WHI investigators and staff for their dedication and the study participants for making the program possible. A listing of WHI investigators can be found at https://www-whi-org.s3.us-west-2.amazonaws.com/wp-content/uploads/WHI-Investigator-Short-List.pdf. The sponsors did not play a role in the study design, collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
- Language
- English
- Date published
- 12/17/2024
- Academic Unit
- Epidemiology; Injury Prevention Research Center
- Record Identifier
- 9984757683602771
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