Association between socioeconomic status and arteriosclerotic cardiovascular disease risk and cause-specific and all-cause mortality: Data from the 2005–2018 National Health and Nutrition Examination Survey

Abstract

BackgroundMorbidity and mortality of arteriosclerotic cardiovascular disease (ASCVD) varied according to socioeconomic status (SES), and evidence on the association between SES and ASCVD risk, and cause-specific and all-cause mortality was nevertheless lacking in large-scale or population-based studies.MethodsA multicycle cross-sectional design and mortality linkage study was conducted using data from Continuous National Health and Nutrition Examination Survey (NHANES) in the United States, including public use linked mortality follow-up files through December 31, 2019. Poverty income ratio (PIR) served as a SES index. A series of weighted Logistic regressions and Cox proportional hazards regressions were used to investigate the association between the SES and the risk of ASCVD and mortality, respectively.ResultsThe study sample was comprised of 30,040 participants aged 20–85 years old during the 2005–2018 period. Weighted Logistic regression models consistently indicated significant relationship between people experiencing poverty and increased risk of ASCVD, and linear trend tests were all statistically significant (all P for trend < 0.001). Additionally, weighted Cox regression analysis consistently demonstrated that the hazards of cause-specific and all-cause mortality increased, with the decrease of each additional income level, and trend analyses indicated similar results (all P for trend < 0.001).ConclusionsOur study confirmed that the SES was strongly linked to living with ASCVD, and cause-specific and all-cause mortality, even after adjusting for other factors that could impact risk, such as the American Heart Association (AHA)'s Life's Simple 7 cardiovascular health score and variables of age, sex, marital status, education, and depression severity.

Low income and education are associated with greater ASCVD risk scores among adults in the US

“…These studies emphasize that SDOH are indeed fundamental drivers of poor health. For example, adjustment for lifestyle factors assessed by life’s simple 7 score, now life’s essential 8, only slightly attenuated the association between SES and ASCVD risk in another study of NHANES participants ( Shen et al, 2022 ). In fact, some studies have suggested that even at best, traditional CVD risk factors can account for only 15–30 percent of the relationship between SES with CVD mortality ( Marmot et al, 1984 , Bhatnagar, 2017 , Henderson et al, 2022 ).…”

“…While the relationship between SES and cardiovascular health (CVH) outcomes has been well studied in various racial/ethnic groups ( Lloyd-Jones et al, 2009 , Brewer et al, 2018 , Gasevic et al, 2015 , Wenger et al, 2022 , Bello et al, 2022 ), fewer studies have evaluated the relationship between SDOH and ASCVD risk among ethnic/racial minorities within the US ( Shen et al, 2022 ). Therefore, the goal of our study was to assess the relationship between SES and ASCVD risk and determine whether these associations were modified by sex and race/ethnicity.…”

The Role of Cancer in the Risk of Cardiovascular and All-Cause Mortality: A Nationwide Prospective Cohort Study

“…Three weighted Cox proportional hazards regression models were used to estimate the associations of cancer and cancer types with the all-cause and cardiovascular-related mortality probabilities after controlling for possible confounding factors. Accumulating evidence suggests disparities in risk factors of CVD in the general population, depending on age, sex, ethnicity, marital status, educational level, income, and the AHA's Life's Simple 7 cardiovascular health score [18][19][20][21][22][23][24][25][26][27][28][29]. Therefore, the multivariable model included the following confounders based on previously published studies: age (<50 or ≥50 years), sex (male or female), ethnicity (White or Non-White), marital status (living with a spouse/partner or living without a spouse/partner), PIR [low (<1.3), middle (1.3-3.5), or high (≥3.5) income], educational level (under 9th grade, 9-11th grade, high school graduate, some college or AA degree, or college graduate or above), and the AHA's Life's Simple 7 cardiovascular health score (continuous).…”

The influence of Life’s Essential 8 on the link between socioeconomic status and depression in adults: a mediation analysis

“…Evidence suggests that less ideal CVH is associated with depression, and interventions targeting diet, physical activity, and sleep may ameliorate depressive symptoms [ 6 , 7 ]. Meanwhile, individuals with low SES are often exposed to unhealthy lifestyles, which in turn significantly increase their susceptibility to cardiovascular disease [ 8 ]. However, important gaps remain.…”