Association of socioeconomic status with cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis

Abstract

Aim Cardiovascular disease (CVD) remains one of the leading causes of mortality worldwide, and several studies have indicated the association between socioeconomic status (SES) with CVD and cardiovascular risk factors (CVRFs). It is necessary to elucidate the association of SES and CVRFs with CVD. Subject and methods We searched PubMed, Embase, Web of Science, and the Cochrane Library for publications, using “socioeconomic status,” “cardiovascular disease,” and corresponding synonyms to obtain literature. The quality of studies was evaluated using the National Institutes of Health Quality Assessment Tool (NIH-QAT). All analyses were performed using Stata V.12.0. Results There were 31 eligible studies included in this meta-analysis. All studies presented a low risk of bias via NIH-QAT assessment. As for CVD incidence/mortality, pooled hazard ratios (HR) of low and middle vs. high income were [HR = 1.22 (1.17–1.28); HR = 1.12 (1.09-1.16)] and [HR = 1.37 (1.21–1.56); HR = 1.19 (1.06–1.34)]. The HR of education were [HR = 1.44 (1.28–1.63); HR = 1.2 (1.11–1.3)] and [HR = 1.5 (1.22–1.83); HR = 1.13 (1.05–1.22)]. The HR of deprivation were [HR = 1.28 (1.16–1.41); HR = 1.07 (1.03–1.11)] and [HR = 1.19 (1.11–1.29); HR = 1.1 (1.02–1.17)]. SES was negatively correlated with CVD outcomes. A subgroup analysis of gender and national income level also yielded a negative correlation, and additional details were also obtained. Conclusions SES is inversely correlated with CVD outcomes and the prevalence of CVRFs. As for CVD incidence, women may be more sensitive to income and education. In terms of CVD mortality, men may be more sensitive to income and education, and people from low- and middle-income countries are sensitive to income and education. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01825-4.

Dementia risk factors in Chilean adults are distinctively associated with social determinants of health. Cross sectional study

“…The association between lower educational level and high metabolic risk in our study is in accordance with a large amount of evidence that has shown an increased prevalence of cardiovascular risk factors, an increased risk of cardiovascular events and cardiovascular death associated with a lower level of education 19 . An inverse association between years of education and cardiovascular risk factors has been shown 19,20 , principally with HSBP 11,19,20 .…”

“…The association between educational level and total family income was expected because as a structural determinant of health, lower educational levels in childhood are associated with lower socioeconomic status in adulthood 11,19,20 . The strong association of lower education/lower income with adult HSBP, high metabolic risk and high multimorbidity could be associated with multiple intermediary risk factors across lifespan, such as unhealthy lifestyle (like physical inactivity in women) and higher exposure to toxins 10 .…”

“…Another possible mechanism associating SDH with hypertension and worse health outcomes in general could be related to an allostatic overload due to the cumulative burden of chronic stress and life events of the more disadvantageous segments of society 10,11 . Finally, lower education/lower wealth is associated with a determined subculture, which could be related to lower awareness of healthcare and/or di culties in healthcare accessibility due to lack of time and/or low availability of healthcare providers where these persons live 19,20 . Indeed, in the English Longitudinal Study of Aging, the increased dementia risk of the population with lower socioeconomic levels was mediated in 52% by the increased proportion of modi able dementia risk factors for this subpopulation 24 .…”

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“…These findings of strong graded associations between lower educational attainment/income with increasing ASCVD risk are consistent with other studies ( Woodward et al, 2015 ). A recent meta-analysis by Wang et al (2023) found that the risk of CVD incidence in low-income groups was 22 % higher than that in high-income groups across 21 included studies. Further, across 10 studies, CVD incidence was 44 % higher in the low education groups when compared to high education groups ( Wang et al, 2023 ).…”

External validation of a cardiovascular risk model for Omani patients with type 2 diabetes mellitus: a retrospective cohort study

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