Highlights
- •We found that lower annual household income, female gender, and Black race were independently associated with development of PAD even with strict multivariable adjustment in this prospectively followed CKD cohort
- •Level of educational attainment was not independently associated with incident PAD, but educational level was a possible surrogate for annual income if missing
- •Given the high incidence of PAD in this cohort, with 19% developing PAD over a median of 10 years, the role of periodic PAD screening by ABI in high-risk subpopulations should be considered
Abstract
Background
The association between socioeconomic factors and development of peripheral artery
disease (PAD) has not been as well characterized compared to other cardiovascular
diseases. We sought to define how annual income, sex, race, and education level are
associated with newly diagnosed PAD in a well-characterized, diverse set of adults
with CKD.
Methods
The Chronic Renal Insufficiency Cohort Study (CRIC) is a multicenter, prospective
cohort study designed to examine risk factors for progression of CKD and cardiovascular
disease. Demographic and clinical data including ankle brachial index (ABI) and interventions
were collected at baseline, as well as yearly during follow-up visits. Annual income
was categorized as: <$25,000, $25,000–50,000, $50,000–100,000, or above $100,000.
We excluded those with pre-existing PAD, defined as enrollment ABI of <0.9 or >1.4,
or missing income data. Cox proportional hazards regression was used to estimate the
risk for incident PAD during CRIC enrollment, defined as a drop in ABI to <0.90 or
a confirmed PAD intervention, including revascularization or amputation.
Results
A total of 3,313 patients met inclusion criteria, the mean age was 58.7 years, 56%
were male, and 42% were Black. Over a median follow-up of 10.1 years, 639 participants
(19%) were newly diagnosed with PAD. After adjusting for cardiovascular risk factors,
all lower levels of annual household income were associated with increased incidence
of PAD (income <$25,000 HR 1.7, 95% CI 1.1–2.4, P = 0.008; income $25,000–50,000 HR 1.5, 95% CI 1.1–2.3, P = 0.009; income $50,000–100,000 HR 1.6, 95% CI 1.2–2.4, P = 0.004), relative to a baseline annual income of >$100,000 (overall P-value = 0.02). In the multivariable model, there was no association between education
level and PAD incidence (P = 0.80). Black race (HR 1.2, 95% CI 1.0–1.5, P = 0.023) and female sex (HR 1.7, 95% CI 1.4–2.0, P < 0.001) were independently associated with PAD incidence. Multiple imputation analysis
provided similar results.
Conclusions
In the CRIC, a multi-center cohort of prospectively followed CKD patients undergoing
yearly CVD surveillance, lower annual household income, female sex, and Black race
were significantly associated with the PAD incidence. In contrast, level of education
was not independently associated with incident PAD.
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Article info
Publication history
Published online: October 14, 2021
Accepted:
July 27,
2021
Received in revised form:
July 26,
2021
Received:
June 22,
2021
Identification
Copyright
Published by Elsevier Inc.
