UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine

Publication Date


Document Type



Aged; Educational Status; Estrogen Replacement Therapy; Female; Follow-Up Studies; Heart Failure; Humans; Incidence; *Income; Middle Aged; *Postmenopause


Cardiology | Clinical Epidemiology | Community Health | Community Health and Preventive Medicine | Epidemiology | Public Health | Therapeutics | Women's Health


OBJECTIVES: The purpose of this study is to estimate the effect of education and income on incident heart failure (HF) hospitalization among post-menopausal women.

BACKGROUND: Investigations of socioeconomic status have focused on outcomes after HF diagnosis, not associations with incident HF. We used data from the Women's Health Initiative Hormone Trials to examine the association between socioeconomic status levels and incident HF hospitalization.

METHODS: We included 26,160 healthy, post-menopausal women. Education and income were self-reported. Analysis of variance, chi-square tests, and proportional hazards models were used for statistical analysis, with adjustment for demographics, comorbid conditions, behavioral factors, and hormone and dietary modification assignments.

RESULTS: Women with household incomes $50,000 a year (16.7/10,000 person-years; p < 0.01). Women with less than a high school education had higher HF hospitalization incidence (51.2/10,000 person-years) than college graduates and above (25.5/10,000 person-years; p < 0.01). In multivariable analyses, women with the lowest income levels had 56% higher risk (hazard ratio: 1.56, 95% confidence interval: 1.19 to 2.04) than the highest income women; women with the least amount of education had 21% higher risk for incident HF hospitalization (hazard ratio: 1.21, 95% confidence interval: 0.90 to 1.62) than the most educated women.

CONCLUSIONS: Lower income is associated with an increased incidence of HF hospitalization among healthy, post-menopausal women, whereas multivariable adjustment attenuated the association of education with incident HF. Elsevier Inc. All rights reserved.


heart failure, socioeconomic status, women

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DOI of Published Version



Shah RU, Winkleby MA, Van Horn L, Phillips LS, Eaton CB, Martin LW, Rosal MC, Manson JE, Ning H, Lloyd-Jones DM, Klein L. Education, income, and incident heart failure in post-menopausal women: the Women's Health Initiative Hormone Therapy Trials. J Am Coll Cardiol. 2011 Sep 27;58(14):1457-64. doi:10.1016/j.jacc.2011.07.006. Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American College of Cardiology

Related Resources

Link to Article in PubMed

PubMed ID