Shifts in socioeconomic status alter cardiovascular disease risk and mortality through modulating Life’s Crucial 9: a prospective cohort study of UK Biobank participants

Background The impact of dynamic socioeconomic status (SES) shifts on cardiovascular disease (CVD) and mortality via cardiovascular health (CVH) remains unclear. Methods We analysed UK Biobank data with complete SES information from baseline and resurvey (n=26 721). SES was measured by income, education and employment. CVH was assessed via Life’s Crucial 9 (LC9). Outcomes included incident CVD, all-cause mortality and CVD mortality. We evaluated the effects of SES shifts on study outcomes, the temporal relationship between SES and CVH, and the mediation effect of CVH using Cox models, cross-lag panel analysis and mediation analysis, respectively. Results Over a median of 5 years, 21.8% of participants shifted to lower SES, 10.2% to higher SES and 68.0% remained stable. Specifically, the total household income was the primary driver of the observed socioeconomic shifts, whereas education level and employment status remained relatively stable. During a median follow-up of 9.5 years, 1100 incident CVD cases and 1122 deaths occurred. After adjusting for covariates, those with other SES shift patterns had lower risks of all outcomes compared with those stable in low SES. Cross-lagged analysis showed baseline SES influenced resurvey CVH. Mediation analysis showed that CVH shift significantly mediated the effects of SES shift on incident CVD (6.33%), with a marginal effect on all-cause mortality (6.69%). Moreover, among the nine LC9 metrics, changes in healthy psychology, hypertension, diabetes mellitus, dyslipidaemia and smoking were the predominant mediators across outcomes. Conclusion The evolution of the LC9 score partially mediated the association between SES shifts and the risks of CVD and mortality. Enhancing compliance with LC9 metrics may serve as one approach to reduce the adverse influences of SES shifts.