Heart Risk Assessments Ignore Poverty

But economics make a big difference in who gets proper care, experts say

FRIDAY, Sept. 16, 2005 (HealthDay News) -- Thousands of lives are being put at risk because factors linked to poverty and class aren't included when experts assess patients' risk for heart disease, British researchers conclude.

This failure to include economic deprivation as a standard risk assessment means that many people are not receiving the lifesaving preventive treatment they need, according to the study.

Currently, when estimating a patient's risk for cardiovascular trouble, doctors look at the standard risk factors of blood pressure, smoking, cholesterol, age, sex and diabetes, pulling them together in the internationally used Framingham Risk Score.

But poverty is not included, even though there's a recognized link between economic hardship and poor health. The study authors said that economic deprivation is left out because there is such variation in country-by-country definitions of deprivation. That makes it difficult to develop an international standard, they said.

Reporting in the Sept. 15 online edition of Heart, researchers at the Cardiovascular Epidemiology Unit at the University of Dundee retrospectively analyzed 10 years of data on 13,000 Scottish men and women using a new deprivation score -- the Scottish Index of Multiple Deprivation (SIMD) -- that includes 31 indicators of economic hardship.

They used the SIMD to compare the "observed risk" of death and illness from heart disease to the "expected risk" using the Framingham score.

The Scottish team found a modest difference in expected risk between the most- and least-deprived people in the study. But there was a sharp difference -- fivefold in women -- in the actual, observed risk between the most- and least-deprived people.

Under the Framingham score, the most-deprived 20 percent of people would receive only half as much primary preventive care in proportion to their future level of heart disease, the researchers said, compared with the least-deprived 20 percent of people.

More information

The American Medical Association has more about heart disease risk factors.

SOURCE: BMJ Specialist Journals, news release, Sept. 115, 2005
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