Family income a strong predictor of coronary heart disease events but not of overall deaths among Turkish adults: a 12-year prospective study

Objective The objective of this study was to assess whether family income affected future deaths and coronary heart disease (CHD) events. Design A prospective population-based survey (the Turkish Adult Risk Factor study) was used. Setting The setting was numerous communities in all geographic regions of Turkey surveyed between 1990 and 2001/2002. Subjects The subjects were a random sample of 2704 men and women 20 years of age or over at baseline examination. Method Monthly family incomes were categorized by the participants into four increasing brackets. Information on the mode of deaths was obtained from first-degree relatives and/or health personnel of the local heath office. The diagnosis of definite or suspected CHD among survivors was based on history, physical examination of the cardiovascular system, and Minnesota coding of resting ECGs. CHD event was defined as newly developed fatal or nonfatal myocardial infarction, new onset stable angina, and/or myocardial ischemia following the baseline survey. After exclusion of participants with CHD at onset, 250 deaths and 297 fatal and nonfatal CHD occurred among 2704 men and women (mean age 41.6 ± 15) during a mean 10.0 years of follow-up. Main results All-cause deaths failed to be significantly associated with income brackets in logistic regression analysis when adjusted for age, sex, and three major risk factors. Systolic blood pressure and cigarette smoking were significant independent predictors of overall mortality. In regard to fatal and nonfatal CHD, even after adjusting for age, sex and three major risk factors, a significant excess was noted in the two lowest brackets as opposed to the high income bracket (relative risk 1.56 and 1.75, respectively, P < 0.03). Conclusions Family income in the Turkish community was not predictive of overall mortality, but was strongly predictive of future CHD events independent of age, sex, and three major factors, posing a huge coronary risk on the individual and the society.