Socioeconomic Inequality and Peripheral Artery Disease Prevalence in US Adults

Study Questions:

What is the association between socioeconomic status (SES) and prevalence of peripheral artery disease (PAD)?


The investigators 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 SES included poverty–income ratio, a ratio of self-reported income relative to the poverty line, and attained education level. The association of PAD and socioeconomic variables was estimated by logistic regression, with data presented as odds ratios (ORs) and 95% confidence intervals (CIs).


Of 6,791 eligible participants, overall weighted prevalence of PAD was 5.8% (standard error, 0.3). PAD prevalence was significantly higher in individuals with low income and lower education. Individuals in the lowest of the six poverty–income ratio categories had more than a twofold increased odds of PAD compared with those in the highest poverty–income ratio category (OR, 2.69; 95% CI, 1.80-4.03; p < 0.0001). This association remained significant even after multivariable adjustment (OR, 1.64; 95% CI, 1.04-2.6; p = 0.034). Lower attained education level also was associated with higher PAD prevalence (OR, 2.8; 95% CI, 1.96-4.0; p < 0.0001), but was no longer significant after multivariable adjustment.


The authors concluded that low income and lower attained education level are associated with PAD in US adults.


This analysis of a nationally representative sample of adults in the United States suggests a strong relationship between indicators of lower SES, such as income or education level, and higher prevalence of PAD. The relationship between PAD and low income persisted even after multivariable adjustment, including adjustment for other socioeconomic variables, such as education and insurance status. There is a need for improved public awareness efforts targeted toward these populations within lower socioeconomic strata that remain at risk. Although there is no current evidence that improving SES will reduce prevalence of PAD or PAD outcomes, wider outreach to populations at risk may improve awareness and potentially lower the adverse impact of PAD.

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