Large health disparities in cardiovascular death in men and women, by ethnicity and socioeconomic status in an urban based population cohort.

Janet M Kist,Rimke C Vos,Rolf H.H Groenwold,Hedwig M.M Vos,Edith D Beishuizen,Albert T.A Mairuhu,Yvo W.J Sijpkens,Gideon W.G Smit,Petra G Van Peet,Jeroen N Struijs,Jeroen N Struijs,Mattijs E Numans

doi:10.1016/j.eclinm.2021.101120

Abstract

BackgroundSocioeconomic status and ethnicity are not incorporated as predictors in country-level cardiovascular risk charts on mainland Europe. The aim of this study was to quantify the sex-specific cardiovascular death rates stratified by ethnicity and socioeconomic factors in an urban population in a universal healthcare system.MethodsAge-standardized death rates (ASDR) were estimated in a dynamic population, aged 45–75 in the city of The Hague, the Netherlands, over the period 2007–2018, using data of Statistics Netherlands. Results were stratified by sex, ethnicity (country of birth) and socioeconomic status (prosperity) and compared with a European cut-off for high-risk countries (ASDR men 225/100,000 and women 175/100,000).FindingsIn total, 3073 CVD deaths occurred during 1·76 million person years follow-up. Estimated ASDRs (selected countries of birth) ranged from 126 (95%CI 89–174) in Moroccan men to 379 (95%CI 272–518) in Antillean men, and from 86 (95%CI 50–138) in Moroccan women to 170 (95%CI 142–202) in Surinamese women. ASDRs in the highest and lowest prosperity quintiles were 94 (95%CI 90–98) and 343 (95%CI 334–351) for men, and 43 (95%CI 41–46) and 140 (95%CI 135–145), for women, respectively.InterpretationIn a diverse urban population, large health disparities in cardiovascular ASDRs exists across ethnic and socioeconomic subgroups. Identifying these high-risk subgroups followed by targeted preventive efforts, might provide a basis for improving cardiovascular health equity within communities. Instead of classifying countries as high-risk or low-risk, a shift towards focusing on these subgroups within countries might be needed.FundingLeiden University Medical Center and Leiden University

Highlights

Cardiovascular diseases are the number one cause of mortality, accounting for 15 million cardiovascular disease (CVD) deaths worldwide [1]
The primary prevention of CVD in Europe is guided by public health policies and the 2016 European Society of Cardiology (ESC) Guidelines on cardiovascular prevention in clinical practice, in which countries are recommended to implement the use
In men 2062 CVD deaths occurred in 879,000 person years and in women 1011 CVD deaths occurred in 876,000 person years (Table 1)

Summary

Introduction

Cardiovascular diseases are the number one cause of mortality, accounting for 15 million cardiovascular disease (CVD) deaths worldwide [1]. No guidelines or studies were found regarding regional or within country CVD risk assessments or adjustment for socioeconomic and ethnic subgroups In preparation for this manuscript Pubmed was searched until May 2021 for "cardiovascular mortality", "cardiovascular prevention", "cardiovascular prediction", "socioeconomic status", "disposable household income", "low income", "ethnicity", "health disparity" and "health inequalities". Results were stratified by sex, ethnicity (country of birth) and socioeconomic status (prosperity) and compared with a European cut-off for high-risk countries (ASDR men 225/100,000 and women 175/100,000). Interpretation: In a diverse urban population, large health disparities in cardiovascular ASDRs exists across ethnic and socioeconomic subgroups. Identifying these high-risk subgroups followed by targeted preventive efforts, might provide a basis for improving cardiovascular health equity within communities.

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