Abstract 013: Cumulative Socioeconomic Disadvantage Across Life Course and Risk of Hospitalization for Heart Failure or Atrial Fibrillation and Mediating Pathways: Prospective Findings From the Moli-Sani Study

Abstract

Introduction: There is lack of data on the association of socioeconomic (SES) disadvantage experienced across life course with the risk of heart failure (HF) or atrial fibrillation (AF). Moreover, little is known on the mechanisms through which SES inequalities shape disease risk. Hypothesis: We assessed the hypothesis of an association between cumulative socioeconomic disadvantage (CSD) with risk of first hospitalization for HF or AF in a large general population-based cohort of Italians, and tested several sets of potential mediators in explaining such associations. Methods: Longitudinal analysis on 21,756 HF- or AF-free men and women (aged≥35 y) recruited in the Moli-sani Study cohort, Italy (2005-2010). A score to estimate CSD over life-course was computed by using childhood SES factors (hot water, overcrowding, housing), 3-level educational attainment, and adulthood SES indicators (occupation, overcrowding, housing). Five sets of pathways were tested as potential mediators: baseline health conditions, lifestyles, and traditional, inflammatory and novel markers of CVD risk (listed in Table). First hospital admissions were recorded by direct linkage with hospital discharge forms. Hazard ratios with 95% confidence intervals (95% CIs) were calculated using multivariable Cox-proportional hazard models. Results: Over a median follow up of 8.2 years, we recorded 836 and 504 admissions to hospital for HF and AF, respectively. A 1-point increment in CSD was associated with 16% and 6% increased risk of HF and AF, respectively. Risk estimates associated with highest CSD, as compared to lowest CSD group, were 2.55 (1.76-3.70) and 1.60 (1.08-2.38) for risk of HF and AF, respectively. Part of such associations was explained by novel biomarkers of CVD risk and baseline lifestyles (Table). Conclusions: HF and AF risks are shaped by cumulative socioeconomic disadvantage across the life course in a large Mediterranean population. Lifestyles and novel markers of CVD risk account for the largest proportion of such associations.