Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study

Abstract

Background Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status-wealth and education-differ among high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management.Methods In this large-scale prospective cohort study, we recruited adults aged between 35 years and 70 years from 367 urban and 302 rural communities in 20 countries. We collected data on families and households in two questionnaires, and data on cardiovascular risk factors in a third questionnaire, which was supplemented with physical examination. We assessed socioeconomic status using education and a household wealth index. Education was categorised as no or primary school education only, secondary school education, or higher education, defined as completion of trade school, college, or university. Household wealth, calculated at the household level and with household data, was defined by an index on the basis of ownership of assets and housing characteristics. Primary outcomes were major cardiovascular disease (a composite of cardiovascular deaths, strokes, myocardial infarction, and heart failure), cardiovascular mortality, and all-cause mortality. Information on specific events was obtained from participants or their family.

Association of Educational Attainment With Adiposity, Type 2 Diabetes, and Coronary Artery Diseases: A Mendelian Randomization Study

“…In the use of MR analysis, we found that longer EA was causally associated with the decreased odds of having cardiometabolic diseases, which is consistent with the traditional observational studies showing that socioeconomic status was associated with obesity, T2D, CVD, and even life expectancy (4,(23)(24)(25)(26)(27).…”

“…Observational studies have consistently showed that socioeconomic status such as low education is associated with an increased risk of cardiovascular disease (CVD) and mortality (1)(2)(3)(4), but disentangling causality is challenging due to the long interval between exposure and outcome. Mendelian randomization (MR) analysis may help to clarify the relationship (5), which utilizes genetic variants as the unconfounded proxies for an exposure of interest and leverages the random assortment of alleles at the time of conception to overcome limitations inherent in observational studies, thus improving causal inferences.…”

Health Inequalities Among Elderly Type 2 Diabetes Mellitus Patients in Japan

“…Many previous studies have demonstrated income inequality in hospitalization, 20 not only in DM patients but also in the general population. 21,22 The present findings are consistent with those of previous studies. This study found that older male DM patients with medium and lowest incomes were at significantly greater risk of hospitalization for diabetic macrovascular complications than those at the highest income level.…”

Risco Cardiovascular e Elegibilidade Para Estatina na Prevenção Primária: Comparação Entre a Diretriz Brasileira e a Diretriz da AHA/ACC

“…Tal fato é especialmente relevante se consideramos que marcadores socioeconômicos, tal como educação, podem influenciar os desfechos cardiovasculares independentemente dos fatores de risco convencionais. 22…”