Socioeconomic disparities and risk of recurrent cardiovascular events and cardiovascular disease-free life expectancy in patients with established cardiovascular disease

AIM: This study aimed to evaluate whether lower socioeconomic status (SES) is related to a higher risk of recurrent cardiovascular disease (CVD) events and reduced CVD-free life expectancy in a large cohort of patients with established CVD. METHODS: 9,477 patients with established CVD from the Utrecht Cardiovascular Cohort - Secondary Manifestations of ARTerial disease (1996-2022) study were included. SES scores were determined at the neighbourhood level using scores provided by the Netherlands Institute for Social Research, based on income, education and unemployment. The relationship between SES and recurrent CVD events was analysed using Cox proportional hazard models, adjusted for age, sex, and traditional CVD risk factors. Event-free life expectancy across SES quintiles was assessed using Kaplan-Meier survival estimates, with age as the time scale and accounting for competing risks. RESULTS: Over a median follow-up of 9.0 years (IQI: 4.8-14.1), 2,090 recurrent CVD events occurred. Unfavourable CVD risk factors were more prevalent among low SES patients, who less frequently used preventive drug treatment. After adjusting for age and sex, patients in the lowest SES quintile had a higher risk of recurrent events compared to the highest SES quintile (HR: 1.35; 95%CI 1.17-1.56). This relationship persisted after adjusting for CVD risk factors potentially mediating the effect. The median event-free life expectancy was 5.5 years (95%CI 2.8-8.0) shorter comparing the lowest to highest SES quintile. CONCLUSIONS: Among patients with established CVD, lower SES is related to a higher risk of recurrent CVD events independent of CVD risk factors, and to a shorter CVD-free survival. These findings underscore the need for targeted interventions to reduce health disparities.