Association of socioeconomic status with cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis

Abstract

Aim: Cardiovascular disease (CVD) remains one of the leading causes of mortality worldwide, and several studies have indicated the association between socioeconomic status (SES) with CVD and cardiovascular risk factors (CVRFs). It is necessary to elucidate the association of SES and CVRFs with CVD. Subject and methods: We searched PubMed, Embase, Web of Science, and the Cochrane Library for publications, using “socioeconomic status,” “cardiovascular disease,” and corresponding synonyms to obtain literature. The quality of studies was evaluated using the National Institutes of Health Quality Assessment Tool (NIH-QAT). All analyses were performed using Stata V.12.0. Results: There were 31 eligible studies included in this meta-analysis. All studies presented a low risk of bias via NIH-QAT assessment. As for CVD incidence/mortality, pooled hazard ratios (HR) of low and middle vs. high income were [HR = 1.22 (1.17–1.28); HR = 1.12 (1.09-1.16)] and [HR = 1.37 (1.21–1.56); HR = 1.19 (1.06–1.34)]. The HR of education were [HR = 1.44 (1.28–1.63); HR = 1.2 (1.11–1.3)] and [HR = 1.5 (1.22–1.83); HR = 1.13 (1.05–1.22)]. The HR of deprivation were [HR = 1.28 (1.16–1.41); HR = 1.07 (1.03–1.11)] and [HR = 1.19 (1.11–1.29); HR = 1.1 (1.02–1.17)]. SES was negatively correlated with CVD outcomes. A subgroup analysis of gender and national income level also yielded a negative correlation, and additional details were also obtained. Conclusions: SES is inversely correlated with CVD outcomes and the prevalence of CVRFs. As for CVD incidence, women may be more sensitive to income and education. In terms of CVD mortality, men may be more sensitive to income and education, and people from low- and middle-income countries are sensitive to income and education.