TY - JOUR

T1 - The impact of modifiable risk factors in the association between socioeconomic status and sudden cardiac death in a prospective cohort study

T2 - equal access to healthcare, unequal outcome

AU - Warming, Peder Emil

AU - Ågesen, Frederik Nybye

AU - Lynge, Thomas Hadberg

AU - Garcia, Rodrigue

AU - Banner, Jytte

AU - Prescott, Eva

AU - Lange, Theis

AU - Jabbari, Reza

AU - Tfelt-Hansen, Jacob

PY - 2023

Y1 - 2023

N2 - Lay Summary Low socioeconomic status (e.g. education and income) has previously been found associated with an increased risk of death and with different heart diseases. Sudden cardiac death (SCD) is among the leading causes of death in the general population, and predicting who is at high risk is difficult. Finding people or groups at high risk is important to improve prevention. That is why we decided to investigate whether socioeconomic status is also associated with the risk of SCD and to calculate the impact of modifiable lifestyle factors on this risk. We followed similar to 10 000 people from a general population cohort for 24 years and observed 822 sudden cardiac deaths.The lowest income and education groups had more than twice the risk of SCD compared with the high groups.Differences in smoking, physical activity, and body mass index explained similar to 20% of this increase.Aims Low socioeconomic status is associated with all-cause mortality and cardiac risk factors. Furthermore, sudden cardiac death (SCD) is among the leading causes of death in the general population, and an identification of high-risk subgroups is needed. The aim of this study was to investigate the association between income and education level and incidence of SCD and to calculate the impact of modifiable mediating risk factors. Methods and results Participants in the Copenhagen City Heart Study were followed up from 1993 to 2016. Sudden cardiac death was identified using high-quality death certificates, autopsy reports, discharge summaries, and national registry data. Hazard ratios were calculated using Cox proportional hazards regression, and adjusted cumulative incidences were predicted using cause-specific Cox models. Mediation analyses were performed using a marginal structural model approach. During 24 years of follow-up, 10 006 people participated, whereof 5514 died during the study period with 822 SCDs. Compared with long education, persons with elementary school level education had an SCD incidence rate ratio (IRR) of 2.48 [95% confidence interval (CI) 1.86-3.31], and low income was likewise associated with an SCD IRR of 2.34 (95% CI 1.85-2.96) compared with high income. In the association between education and SCD, the combined mediating effect of smoking, physical activity, and body mass index accounted for similar to 20% of the risk differences. Conclusion We observed an inverse association between both income and education and the risk of SCD, which was only in part explained by common cardiac risk factors, implying that further research into the competing causes of SCD is needed and stressing the importance of targeted preventive measures.

AB - Lay Summary Low socioeconomic status (e.g. education and income) has previously been found associated with an increased risk of death and with different heart diseases. Sudden cardiac death (SCD) is among the leading causes of death in the general population, and predicting who is at high risk is difficult. Finding people or groups at high risk is important to improve prevention. That is why we decided to investigate whether socioeconomic status is also associated with the risk of SCD and to calculate the impact of modifiable lifestyle factors on this risk. We followed similar to 10 000 people from a general population cohort for 24 years and observed 822 sudden cardiac deaths.The lowest income and education groups had more than twice the risk of SCD compared with the high groups.Differences in smoking, physical activity, and body mass index explained similar to 20% of this increase.Aims Low socioeconomic status is associated with all-cause mortality and cardiac risk factors. Furthermore, sudden cardiac death (SCD) is among the leading causes of death in the general population, and an identification of high-risk subgroups is needed. The aim of this study was to investigate the association between income and education level and incidence of SCD and to calculate the impact of modifiable mediating risk factors. Methods and results Participants in the Copenhagen City Heart Study were followed up from 1993 to 2016. Sudden cardiac death was identified using high-quality death certificates, autopsy reports, discharge summaries, and national registry data. Hazard ratios were calculated using Cox proportional hazards regression, and adjusted cumulative incidences were predicted using cause-specific Cox models. Mediation analyses were performed using a marginal structural model approach. During 24 years of follow-up, 10 006 people participated, whereof 5514 died during the study period with 822 SCDs. Compared with long education, persons with elementary school level education had an SCD incidence rate ratio (IRR) of 2.48 [95% confidence interval (CI) 1.86-3.31], and low income was likewise associated with an SCD IRR of 2.34 (95% CI 1.85-2.96) compared with high income. In the association between education and SCD, the combined mediating effect of smoking, physical activity, and body mass index accounted for similar to 20% of the risk differences. Conclusion We observed an inverse association between both income and education and the risk of SCD, which was only in part explained by common cardiac risk factors, implying that further research into the competing causes of SCD is needed and stressing the importance of targeted preventive measures.

KW - Sudden cardiac death

KW - Socioeconomic status

KW - General population

KW - Mediation analysis

KW - CORONARY-HEART-DISEASE

KW - TEMPORAL TRENDS

KW - NATURAL DIRECT

KW - UNITED-STATES

KW - BURDEN

KW - EPIDEMIOLOGY

KW - POPULATION

KW - NATIONWIDE

KW - EDUCATION

KW - ACCURACY

U2 - 10.1093/eurjpc/zwad086

DO - 10.1093/eurjpc/zwad086

M3 - Journal article

C2 - 36943322

VL - 30

SP - 1526

EP - 1534

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

SN - 2047-4873

IS - 14

ER -