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Clin Res Cardiol. 2020 Jan;109(1):103-114. doi: 10.1007/s00392-019-01494-y. Epub 2019 May 29.

Area-based socioeconomic status and mortality: the Ludwigshafen Risk and Cardiovascular Health study.

Author information

1
Vth Department of Medicine (Nephrology Hypertensiology, Rheumatology, Endocrinology, Diabetology) Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
2
Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria.
3
SYNLAB Academy, SYNLAB Holding Deutschland GmbH, Augsburg/Mannheim, Germany.
4
Vth Department of Medicine (Nephrology Hypertensiology, Rheumatology, Endocrinology, Diabetology) Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. marcus.kleber@medma.uni-heidelberg.de.
5
Mannheim Institute of Public Health and Preventive Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.

Abstract

BACKGROUND:

Low individual socioeconomic status (SES) is a known risk factor for morbidity and mortality. A related measure is the area-based SES (abSES), which describes the average SES of a region. The association of measures of abSES with morbidity and mortality is less well studied.

METHODS:

The Ludwigshafen Risk and Cardiovascular Health study consists of 3316 patients hospitalized for coronary angiography between 1997 and 2000 at a tertiary care centre in Germany. Patients were followed up for a median of 10 years. Two measures of abSES were used: the regional purchasing index (PPI, data obtained from IQVIA GmbH) and the German Index of Socioeconomic Deprivation (GISD, developed by the Robert-Koch Institute). The association of abSES with disease and with mortality was analysed using logistic regression and Cox proportional hazards regression, respectively.

RESULTS:

Study participants living in regions with higher abSES had lower HbA1c and high-sensitive C-reactive protein. A higher abSES was associated with lower prevalence of active smoking, vitamin D deficiency and diabetes mellitus. We further found significantly increased mortality for participants in the lowest PPI quartile (age- and sex-adjusted hazard ratio (95% CI) of 0.58 (0.38-0.90) as compared to the first quartile), and in the highest GISD tertile (HR of 1.32 (1.13-1.54) as compared to the first tertile).

CONCLUSION:

Living in an area with a low abSES was associated with a higher burden of diabetes mellitus, a higher percentage of severe vitamin D deficiency, higher systemic inflammation and a significant increase in mortality.

KEYWORDS:

Diabetes mellitus; German Index of Socioeconomic Deprivation; Mortality; Purchasing power index; Socioeconomic status

PMID:
31144063
DOI:
10.1007/s00392-019-01494-y

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