Socioeconomic Inequality and Peripheral Artery Disease Prevalence in US Adults

Background-Lower socioeconomic status is associated with cardiovascular disease. We sought to determine whether there is a higher prevalence of peripheral artery disease (PAD) in individuals with lower socioeconomic status. Methods and Results-We analyzed data from the National Health and Nutrition Examination Survey 1999 to 2004. PAD was defined based on an ankle-brachial index <= 0.90. Measures of socioeconomic status included poverty-income ratio, a ratio of self-reported income relative to the poverty line, and attained education level. Of 6791 eligible participants, overall weighted prevalence of PAD was 5.8% (SE, 0.3). PAD prevalence was significantly higher in individuals with low income and lower education. Individuals in the lowest of the 6 poverty-income ratio categories had more than a 2-fold increased odds of PAD compared with those in the highest poverty-income ratio category (odds ratio, 2.69; 95% confidence interval, 1.80-4.03; P<0.0001). This association remained significant even after multivariable adjustment (odds ratio, 1.64; 95% confidence interval, 1.04-2.6; P=0.034). Lower attained education level also associated with higher PAD prevalence (odds ratio, 2.8; 95% confidence interval, 1.96-4.0; P<0.0001) but was no longer significant after multivariable adjustment. Conclusions-Low income and lower attained education level are associated with PAD in US adults. These data suggest that individuals of lower socioeconomic status remain at high risk and highlight the need for education and advocacy efforts focused on these at-risk populations.