{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T10:40:44Z","timestamp":1793356844262,"version":"4.5.0"},"reference-count":62,"publisher":"Oxford University Press (OUP)","issue":"21","license":[{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100007687","name":"Korean Diabetes Association","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Korean government"},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and Information and Communication Technology","doi-asserted-by":"publisher","award":["2019R1I1A1A01061188"],"award-info":[{"award-number":["2019R1I1A1A01061188"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and Information and Communication Technology","doi-asserted-by":"publisher","award":["2023-00243106"],"award-info":[{"award-number":["2023-00243106"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Longitudinal change in income is crucial in explaining cardiovascular health inequalities. However, there is limited evidence for cardiovascular disease (CVD) risk associated with income dynamics over time among individuals with type 2 diabetes (T2D).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a nationally representative sample from the Korean National Health Insurance Service database, 1 528 108 adults aged 30\u201364 with T2D and no history of CVD were included from 2009 to 2012 (mean follow-up of 7.3 years). Using monthly health insurance premium information, income levels were assessed annually for the baseline year and the four preceding years. Income variability was defined as the intraindividual standard deviation of the percent change in income over 5 years. The primary outcome was a composite event of incident fatal and nonfatal CVD (myocardial infarction, heart failure, and stroke) using insurance claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>High-income variability was associated with increased CVD risk (HRhighest vs. lowest quartile 1.25, 95% CI 1.22\u20131.27; Ptrend &amp;lt; .001). Individuals who experienced an income decline (4 years ago vs. baseline) had increased CVD risk, which was particularly notable when the income decreased to the lowest level (i.e. Medical Aid beneficiaries), regardless of their initial income status. Sustained low income (i.e. lowest income quartile) over 5 years was associated with increased CVD risk (HRn = 5 years vs. n = 0 years 1.38, 95% CI 1.35\u20131.41; Ptrend &amp;lt; .0001), whereas sustained high income (i.e. highest income quartile) was associated with decreased CVD risk (HRn = 5 years vs. n = 0 years 0.71, 95% CI 0.70\u20130.72; Ptrend &amp;lt; .0001). Sensitivity analyses, exploring potential mediators, such as lifestyle-related factors and obesity, supported the main results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher income variability, income declines, and sustained low income were associated with increased CVD risk. Our findings highlight the need to better understand the mechanisms by which income dynamics impact CVD risk among individuals with T2D.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehae132","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T17:40:42Z","timestamp":1708450842000},"page":"1920-1933","source":"Crossref","is-referenced-by-count":38,"title":["Income variability and incident cardiovascular disease in diabetes: a population-based cohort study"],"prefix":"10.1093","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5879-6879","authenticated-orcid":false,"given":"Yong-Moon Mark","family":"Park","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock, AR , USA"},{"name":"Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock, AR , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1524-1742","authenticated-orcid":false,"given":"Jong-Ha","family":"Baek","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock, AR , USA"},{"name":"Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine , Changwon , South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong Seok","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Arizona , Tucson, AZ , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7528-7988","authenticated-orcid":false,"given":"Tali","family":"Elfassy","sequence":"additional","affiliation":[{"name":"Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine , Miami, FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare C","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock, AR , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1162-8824","authenticated-orcid":false,"given":"Mario","family":"Schootman","sequence":"additional","affiliation":[{"name":"Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock, AR , USA"},{"name":"Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences \u00a0 Northwest, Springdale, AR , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3378-2187","authenticated-orcid":false,"given":"Marie-Rachelle","family":"Narcisse","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences \u00a0 Northwest, Springdale, AR , USA"},{"name":"Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University , Providence, RI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3703-1479","authenticated-orcid":false,"given":"Seung-Hyun","family":"Ko","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea , Seoul , South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4033-6241","authenticated-orcid":false,"given":"Pearl A","family":"McElfish","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences \u00a0 Northwest, Springdale, AR , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R","family":"Thomsen","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock, AR , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin C","family":"Amick","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock, AR , USA"},{"name":"Winthrop P. 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