Pathways From Socioeconomic Factors to Major Cardiovascular Events Among Postmenopausal Veteran and Nonveteran Women: Findings From the Women's Health Initiative

Authors

Hind A Beydoun
May A Beydoun
Rebecca L Kinney
Simin Liu
Rona Yu
Matthew Allison
Robert B Wallace
Qian Xiao
Longjian Liu
Philippe Gradidge
Su Yon Jung
Hilary A Tindle
Shawna Follis
Robert Brunner
Jack Tsai

Publication Date

12-17-2024

Journal

Journal of the American Heart Association

Abstract

BACKGROUND: Cardiovascular disease (CVD) remains a leading cause of death for women in the United States, with veterans being at potentially higher risk than their nonveteran counterparts due to accelerated aging and distinct biopsychosocial mechanisms. We examined pathways between selected indicators of socioeconomic status (SES) such as education, occupation, household income, and neighborhood SES and major CVD events through lifestyle and health characteristics among veteran and nonveteran postmenopausal women.

METHODS AND RESULTS: A total of 121 286 study-eligible WHI (Women's Health Initiative) participants (3091 veterans and 118 195 nonveterans) were prospectively followed for an average of 17 years, during which 16 108 major CVD events were documented. Using generalized structural equations modeling coupled with survival analysis techniques, we estimated the effects of SES on major CVD events through smoking, body mass index, comorbidities, cardiometabolic risk factors, and self-rated health, controlling for WHI component, region, age, race, ethnicity, marital status, and health care provider access. Among veterans, SES characteristics were indirectly related to major CVD events through body mass index, comorbidities, cardiometabolic risk factors, and self-rated health. Among nonveterans, lower education (β= 0.2,

CONCLUSIONS: Nonveteran postmenopausal women exhibit more complex pathways between SES and major CVD events than their veteran counterparts, informing the design, conduct, and evaluation of preventive strategies targeting CVD by veteran status.

Keywords

Humans, Female, Postmenopause, Middle Aged, Cardiovascular Diseases, Aged, Women's Health, United States, Veterans, Socioeconomic Factors, Prospective Studies, Risk Factors, Veterans Health, Risk Assessment, Social Determinants of Health, cardiovascular disease, postmenopausal, socioeconomic status, veteran, women, Epidemiology, Women, Cardiovascular Disease

DOI

10.1161/JAHA.124.037253

PMID

39673348

PMCID

PMC11935538

PubMedCentral® Posted Date

12-14-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes