Income-Based Disparity in Cardiovascular Outcomes for Patients With Type 2 Diabetes Identified

By Rebecca Araujo - February 15, 2023

There is a growing disparity in cardiovascular health outcomes among people with diabetes based on socioeconomic status, according to an analysis published in Diabetes Care.

The study analyzed data over a 25-year period in Ontario, Canada, comprising more than 1.5 million people with type 2 diabetes from 1995-2019. The primary outcomes were age-, sex-, and income-related differences in cardiovascular hospitalization among this population. Rates of hospitalization for the following conditions were analyzed: acute myocardial infarction, stroke, heart failure, and lower-extremity amputation.

Diabetes and Heart Health

Individuals with diabetes are more likely to develop heart disease and other conditions that are risk factors for poor cardiovascular outcomes, such as high blood pressure. Diabetes is also associated with a greater risk of heart failure and stroke. According to the American Heart Association, diabetes is one of the 7 major controllable risk factors for cardiovascular disease.

Trends in Cardiovascular Outcomes

The authors noted a trend of reduced rates o acute myocardial infarction over the study period (P<.0001), “such that the rate in 2019 was less than half the rate in 1995,” they wrote. Acute myocardial infarction hospitalization rates were 7.2 versus 15.4 hospitalizations per 1000 person-years in 2019 and 1995, respectively. Rates of hospitalization for stroke, heart failure, and amputation also fell over time (P<.0001), but the authors noted that the declining hospitalization rates have stabilized since 2010.

However, the authors wrote, “this apparent stabilization concealed a growing income-related disparity.” Although hospitalization among wealthier patients continued to decline throughout the 2010s, there was an increase in hospitalizations for lower-income patients. This income-related disparity was  significant across all conditions analyzed (P<.0001). For example, from 2010-2019, rates of hospitalization for heart failure decreased from 13.8 to 13.1 per 1000 person-years among the highest-income patients. However, this rate rose from 17.3 to 19.4 per 1000 person-years in the lowest-income population during the same period.

The authors concluded, “During a quarter-century of follow-up, cardiovascular hospitalization rates among people with diabetes fell. However, the apparent stabilization in rates of stroke, heart failure, and amputation in recent years masks the fact that rates have risen for lower-income individuals.”

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