Abstract
Aim
Low socioeconomic-position (SEP) is associated with increased prevalence of cardiovascular
disease. Whether this is caused by earlier development of atherosclerotic calcifications
is not well understood. This study aimed to investigate the association between SEP
and coronary artery calcium score (CACS) in a population presenting with symptoms
suggestive of obstructive coronary artery disease.
Methods
We included 50,561 patients (mean age 57 ± 11, 53% women) from a national registry
undergoing coronary computed tomography angiography (CTA) from 2008 to 2019. CACS
was used as outcome in categories; 1–399 and ≥ 400 in regression analyses. SEP was
obtained from central registries and defined as mean personal income and length of
education.
Results
The number of risk factors were negatively associated with income and education among
both men and women. The adjusted OR of having a CACS≥400 was 1.67(1.50–1.86) among
women with <10 years of education compared to >13 years. For men the corresponding
OR was 1.03(0.91–1.16).
For women with low income the adjusted OR of CACS ≥400 was 2.29(1.96–2.69) using high
income as a reference. For men the corresponding OR was 1.13(0.99–1.29).
Conclusion
In patients referred for coronary CTA we found an increased level of risk factors
among men and women with short education and low income. Among women with longer education
and a higher income we demonstrated a lower CACS compared to other women and men.
Socioeconomic differences seem to affect the development of CACS beyond what can be
explained by traditional risk factors. Part of the observed result may be due to referral
bias.
ClinicalTrials.gov identifier
None.
Graphical abstract
Graphical Abstract
Keywords
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References
- Socioeconomic inequalities in cardiovascular disease mortality; an international study.Eur Heart J. 2000; 21: 1141-1151
- Trends in socioeconomic inequalities in five major risk factors for cardiovascular disease in the Korean population: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey, 2001-2014.BMJ Open. 2017; 7e014070
- Socioeconomic status and cardiovascular outcomes: challenges and interventions.Circulation. 2018; 137: 2166-2178
- Social class differences in coronary heart disease in middle-aged British men: implications for prevention.Int J Epidemiol. 2004; 33: 289-296
- Educational inequalities in ischaemic heart disease mortality in 44,000 Norwegian women and men: the influence of psychosocial and behavioural factors. The HUNT Study.Scand J Publ Health. 2010; 38: 678-685
- Marital status, education, and risk of acute myocardial infarction in Mainland China: the INTER-HEART study.J Epidemiol. 2012; 22: 123-129
- Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study.Eur J Epidemiol. 2013; 28: 807-814
- Women's relative immunity to the socio-economic health gradient: artifact or real?.Glob Health Action. 2015; 827259
- Social inequalities in mortality by cause among men and women in France.J Epidemiol Community Health. 2009; 63: 197-202
- Existing data sources for clinical epidemiology: the Western Denmark Heart Registry.Clin Epidemiol. 2010; 2: 137-144
- Incorporating coronary calcification into pre-test assessment of the likelihood of coronary artery disease.J Am Coll Cardiol. 2020; 76: 2421-2432
- Quantification of coronary artery calcium using ultrafast computed tomography.J Am Coll Cardiol. 1990; 15: 827-832
- Danish education registers.Scand J Publ Health. 2011; 39: 91-94
- 2016: 1341
- Danish registers on personal income and transfer payments.Scand J Publ Health. 2011; 39: 103-105
- Impact of socioeconomic status on coronary artery calcification.Eur J Prev Cardiol. 2018; 25: 1756-1764
- Income inequalities in case death of ischaemic heart disease in The Netherlands: a national record-linked study.J Epidemiol Community Health. 2012; 66: 1159-1166
- Socioeconomic indicators and the risk of acute coronary heart disease events: comparison of population-based data from the United States and Finland.Ann Epidemiol. 2011; 21: 572-579
- Gender differences in coronary heart disease.Neth Heart J. 2010; 18: 598-602
- Danish men consult GPs less than women but attend hospital more and have greater mortality.Br Med J. 2007; 335: 1010-1011
- 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes.Eur Heart J. 2020; 41: 407-477
- Implementation of coronary computed tomography angiography as nationally recommended first-line test in patients with suspected chronic coronary syndrome: impact on the use of invasive coronary angiography and revascularization.Eur Heart J Cardiovasc Imaging. 2020; 21: 1353-1362
- The western Denmark cardiac computed tomography registry: a review and validation study.Clin Epidemiol. 2015; 7: 53-64
- Quality assurance of the Western Denmark Heart Registry, a population-based healthcare register.Dan Med J. 2017; 64
Article info
Publication history
Published online: February 14, 2023
Accepted:
February 1,
2023
Received in revised form:
January 26,
2023
Received:
September 11,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
