Methods: For this secondary analysis, the data of two national studies among 996 midlife women (234 Hispanics, 196 Asian, 238 African-Americans, and 298 Whites) were analyzed. The instruments used in the parent studies included: questions on background characteristics, questions on socioeconomic factors, and the Cardiovascular Symptom Index for Midlife Women (CSIMW). The items of CSIMW were adopted from the Midlife Women’s Symptom Index (MSI). The CSIMW included 25 questions that were chosen based on an extensive literature review on midlife women’s symptoms associated with CVDs. In this analysis, the Cronbach’s alpha of the CSIMW was .87 for the prevalence subscale and .89 for the severity subscale. The data were analyzed using Poisson regression analysis and multiple logistic regression analyses. Poisson regression analyses were conducted to determine the associations of socioeconomic factors to the total numbers of cardiovascular symptoms. Since the assumption of normal distribution (tested with Kolmogorov-Smirnov test) was violated (p<0.001), Poisson regression analyses were used. Logistic regression analyses were conducted to decide the associations of socioeconomic factors to the total severity scores of cardiovascular symptoms with the Hosmer & Lemeshow goodness of fit test.
Results: In total participants, socioeconomic factors including education (no college degree) and family income (very low and somewhat low) were positively related with the total numbers of cardiovascular symptoms (p<.05). In Whites, socioeconomic factors including education (no college degree), family income (very low), and employment were positively related with the total numbers of cardiovascular symptoms (p<.05). In Hispanics, family income (somewhat low) was positively related with the total numbers of cardiovascular symptoms while employment was negatively related with them (p<.05). In African Americans, only family income (very low and somewhat low) was positively related with the total numbers of cardiovascular symptoms. In Asians, family income (very low) was positively related with the total numbers of cardiovascular symptoms while employment was negatively related with them (p<.05).
Multiple logistic regression analyses were conducted while the participants were categorized into two groups by the mean total severity scores of total participants and individual ethnic groups. In total participants, very low (OR=3.71, 95% CI=1.97–6.99) and somewhat low family income (OR=1.84, 95% CI=1.14–2.97) were significantly related with the total severity scores of cardiovascular symptoms. In Whites, very low family income (OR=4.39, 95% CI=1.38–14.01) was significantly related with the total severity scores. In Hispanics, employment (OR=0.19, 95% CI=0.04–0.83) was significantly related with them. In Asians, very low family income (OR=7.82, 95% CI=1.30–47.10) was significantly related with them. In African Americans, none of the variables was significantly related with the total severity scores of cardiovascular symptoms (p>.05).
Conclusion: The findings of this secondary analysis supported significant associations of socioeconomic factors to cardiovascular symptoms experienced during menopausal transition among four major ethnic groups of midlife women in the U.S. Considering inherent characteristics of a secondary analysis (e.g., lack of controllability in the collected data), further studies on the associations of socioeconomic factors to midlife women’s cardiovascular symptoms are imperative to confirm the findings.