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Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Low ‐ and High ‐ Income Participants: Findings From the Reasons for Geographical and Racial Differences in Stroke ( REGARDS ) Study

View Article: PubMed Central - PubMed

ABSTRACT

Background: Psychosocial risk for cardiovascular disease (CVD) may be especially deleterious in persons with low socioeconomic status. Most work has focused on psychosocial factors individually, but emerging research suggests that the confluence of psychosocial risk may be particularly harmful. Using data from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study, we examined associations among depressive symptoms and stress, alone and in combination, and incident CVD and all‐cause mortality as a function of socioeconomic status.

Methods and results: At baseline, 22 658 participants without a history of CVD (58.8% female, 41.7% black, mean age 63.9±9.3 years) reported on depressive symptoms, stress, annual household income, and education. Participants were classified into 1 of 3 psychosocial risk groups at baseline: (1) neither depressive symptoms nor stress, (2) either depressive symptoms or stress, or (3) both depressive symptoms and stress. Cox proportional hazards models were used to predict physician‐adjudicated incident total CVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) and all‐cause mortality over a median of 7.0 years (interquartile range 5.4–8.3 years) of follow‐up. In fully adjusted models, participants with both depressive symptoms and stress had the greatest elevation in risk of developing total CVD (hazard ratio 1.48, 95% CI 1.21–1.81) and all‐cause mortality (hazard ratio 1.33, 95% CI 1.13–1.56) but only for those with low income (<$35 000) and not high (≥$35 000) income. This pattern of results was not observed in models stratified by education.

Conclusions: Findings suggest that screening for a combination of elevated depressive symptoms and stress in low‐income persons may help identify those at increased risk of incident CVD and mortality.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier survival curves for all‐cause mortality in participants with low and high income. REGARDS indicates Reasons for Geographical and Racial Differences in Stroke.
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jah31814-fig-0002: Kaplan–Meier survival curves for all‐cause mortality in participants with low and high income. REGARDS indicates Reasons for Geographical and Racial Differences in Stroke.

Mentions: Over the course of follow‐up, there were 2568 deaths due to all causes. Cumulative incidence of all‐cause mortality was higher for those with low (versus high) income and highest for those with low income and 1 or both psychosocial risk factors (Kaplan–Meier survival curves shown in Figure 2). The age‐adjusted incidence rates per 1000 person‐years of follow‐up for all‐cause mortality for participants with low income were staggering, and they were progressively higher as a function of greater psychosocial risk: 19.2 for those with neither elevated depressive symptoms nor stress, 22.8 for those with either elevated depressive symptoms or stress, and 28.4 for those with both elevated depressive symptoms and stress (Table 2). Similar to the total CVD analysis, low‐income participants with elevated depressive symptoms and stress had increased risk of all‐cause mortality compared with low‐income participants with neither elevated depressive symptoms nor stress (HR 1.33 [95% CI 1.13–1.56] in the final model adjusting for sociodemographics, physiological and medical CVD risk factors, health behaviors, and the Physical Health Component score of the SF‐12). HRs for all‐cause mortality for low‐income participants with either elevated depressive symptoms or stress compared with low‐income participants with neither psychosocial risk factor were also elevated, although the HR was not significantly different from 1 in the final model (Table 2). Unlike the total CVD analysis, there was some evidence that psychosocial risk factors were also associated with increased risk of all‐cause mortality for high‐income participants. High‐income participants with 1 or both psychosocial risk factors had significantly elevated risk of all‐cause mortality compared with high‐income participants with neither psychosocial risk factor in models adjusting for sociodemographics and physiological and medical CVD risk factors (models 1 and 2 are described in Table 2; participants with one psychosocial risk factor also had significantly elevated risk in model 3). However, the HRs for the groups with 1 or both psychosocial risk factors were not significantly >1 in the final model that additionally adjusted for the Physical Component Summary score of the SF‐12 (Table 2).


Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Low ‐ and High ‐ Income Participants: Findings From the Reasons for Geographical and Racial Differences in Stroke ( REGARDS ) Study
Kaplan–Meier survival curves for all‐cause mortality in participants with low and high income. REGARDS indicates Reasons for Geographical and Racial Differences in Stroke.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121497&req=5

jah31814-fig-0002: Kaplan–Meier survival curves for all‐cause mortality in participants with low and high income. REGARDS indicates Reasons for Geographical and Racial Differences in Stroke.
Mentions: Over the course of follow‐up, there were 2568 deaths due to all causes. Cumulative incidence of all‐cause mortality was higher for those with low (versus high) income and highest for those with low income and 1 or both psychosocial risk factors (Kaplan–Meier survival curves shown in Figure 2). The age‐adjusted incidence rates per 1000 person‐years of follow‐up for all‐cause mortality for participants with low income were staggering, and they were progressively higher as a function of greater psychosocial risk: 19.2 for those with neither elevated depressive symptoms nor stress, 22.8 for those with either elevated depressive symptoms or stress, and 28.4 for those with both elevated depressive symptoms and stress (Table 2). Similar to the total CVD analysis, low‐income participants with elevated depressive symptoms and stress had increased risk of all‐cause mortality compared with low‐income participants with neither elevated depressive symptoms nor stress (HR 1.33 [95% CI 1.13–1.56] in the final model adjusting for sociodemographics, physiological and medical CVD risk factors, health behaviors, and the Physical Health Component score of the SF‐12). HRs for all‐cause mortality for low‐income participants with either elevated depressive symptoms or stress compared with low‐income participants with neither psychosocial risk factor were also elevated, although the HR was not significantly different from 1 in the final model (Table 2). Unlike the total CVD analysis, there was some evidence that psychosocial risk factors were also associated with increased risk of all‐cause mortality for high‐income participants. High‐income participants with 1 or both psychosocial risk factors had significantly elevated risk of all‐cause mortality compared with high‐income participants with neither psychosocial risk factor in models adjusting for sociodemographics and physiological and medical CVD risk factors (models 1 and 2 are described in Table 2; participants with one psychosocial risk factor also had significantly elevated risk in model 3). However, the HRs for the groups with 1 or both psychosocial risk factors were not significantly >1 in the final model that additionally adjusted for the Physical Component Summary score of the SF‐12 (Table 2).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Psychosocial risk for cardiovascular disease (CVD) may be especially deleterious in persons with low socioeconomic status. Most work has focused on psychosocial factors individually, but emerging research suggests that the confluence of psychosocial risk may be particularly harmful. Using data from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study, we examined associations among depressive symptoms and stress, alone and in combination, and incident CVD and all‐cause mortality as a function of socioeconomic status.

Methods and results: At baseline, 22 658 participants without a history of CVD (58.8% female, 41.7% black, mean age 63.9±9.3 years) reported on depressive symptoms, stress, annual household income, and education. Participants were classified into 1 of 3 psychosocial risk groups at baseline: (1) neither depressive symptoms nor stress, (2) either depressive symptoms or stress, or (3) both depressive symptoms and stress. Cox proportional hazards models were used to predict physician‐adjudicated incident total CVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) and all‐cause mortality over a median of 7.0 years (interquartile range 5.4–8.3 years) of follow‐up. In fully adjusted models, participants with both depressive symptoms and stress had the greatest elevation in risk of developing total CVD (hazard ratio 1.48, 95% CI 1.21–1.81) and all‐cause mortality (hazard ratio 1.33, 95% CI 1.13–1.56) but only for those with low income (<$35 000) and not high (≥$35 000) income. This pattern of results was not observed in models stratified by education.

Conclusions: Findings suggest that screening for a combination of elevated depressive symptoms and stress in low‐income persons may help identify those at increased risk of incident CVD and mortality.

No MeSH data available.


Related in: MedlinePlus