TY - JOUR
T1 - Inequalities by Income in the Prevalence of Cardiovascular Disease and Its Risk Factors in the Adult Population of Catalonia
AU - Mullachery, Pricila H.
AU - Vela, Emili
AU - Cleries, Montse
AU - Comin-Colet, Josep
AU - Nasir, Khurram
AU - Diez Roux, Ana V.
AU - Cainzos-Achirica, Miguel
AU - Mauri, Josepa
AU - Bilal, Usama
N1 - Publisher Copyright:
© 2022 The Authors.
PY - 2022/9/6
Y1 - 2022/9/6
N2 - BACKGROUND: Understanding the magnitude of cardiovascular disease (CVD) inequalities is the first step toward addressing them. The linkage of socioeconomic and clinical data in universal health care settings provides critical information to characterize CVD inequalities. METHODS AND RESULTS: We employed a prospective cohort design using electronic health records data from all residents of Catalonia aged 18+ between January and December of 2019 (N=6 332 228). We calculated age-adjusted sex-specific prevalence of 5 CVD risk factors (diabetes, hypertension, hyperlipidemia, obesity, and smoking), and 4 CVDs (coronary heart disease, cerebrovascular disease, atrial fibrillation, and heart failure). We categorized income into high, moderate, low, and very low according to individual income (tied to prescription copayments) and receipt of welfare support. We found large inequalities in CVD and CVD risk factors among men and women. CVD risk factors with the largest inequalities were diabetes, smoking, and obesity, with prevalence rates 2-or 3-fold higher for those with very low (versus high) income. CVDs with the largest inequalities were cerebrovascular disease and heart failure, with prevalence rates 2 to 4 times higher for men and women with very low (versus high) income. Inequalities varied by age, peaking at midlife (30–50 years) for most diseases, while decreasing gradually with age for smoking. CONCLUSIONS: We found wide and heterogeneous inequalities by income in 5 CVD risk factors and 4 CVD. Our findings in a region with a high-quality public health care system and universal coverage stress that strong equity-promoting policies are necessary to reduce disparities in CVD.
AB - BACKGROUND: Understanding the magnitude of cardiovascular disease (CVD) inequalities is the first step toward addressing them. The linkage of socioeconomic and clinical data in universal health care settings provides critical information to characterize CVD inequalities. METHODS AND RESULTS: We employed a prospective cohort design using electronic health records data from all residents of Catalonia aged 18+ between January and December of 2019 (N=6 332 228). We calculated age-adjusted sex-specific prevalence of 5 CVD risk factors (diabetes, hypertension, hyperlipidemia, obesity, and smoking), and 4 CVDs (coronary heart disease, cerebrovascular disease, atrial fibrillation, and heart failure). We categorized income into high, moderate, low, and very low according to individual income (tied to prescription copayments) and receipt of welfare support. We found large inequalities in CVD and CVD risk factors among men and women. CVD risk factors with the largest inequalities were diabetes, smoking, and obesity, with prevalence rates 2-or 3-fold higher for those with very low (versus high) income. CVDs with the largest inequalities were cerebrovascular disease and heart failure, with prevalence rates 2 to 4 times higher for men and women with very low (versus high) income. Inequalities varied by age, peaking at midlife (30–50 years) for most diseases, while decreasing gradually with age for smoking. CONCLUSIONS: We found wide and heterogeneous inequalities by income in 5 CVD risk factors and 4 CVD. Our findings in a region with a high-quality public health care system and universal coverage stress that strong equity-promoting policies are necessary to reduce disparities in CVD.
KW - cardiovascular disease
KW - health disparities
KW - health equity
KW - income
KW - socioeconomic status
KW - Heart Failure/epidemiology
KW - Diabetes Mellitus/epidemiology
KW - Prevalence
KW - Prospective Studies
KW - Cardiovascular Diseases/epidemiology
KW - Humans
KW - Middle Aged
KW - Risk Factors
KW - Income
KW - Obesity/epidemiology
KW - Male
KW - Socioeconomic Factors
KW - Adult
KW - Female
KW - Spain/epidemiology
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U2 - 10.1161/JAHA.122.026587
DO - 10.1161/JAHA.122.026587
M3 - Article
C2 - 36000437
AN - SCOPUS:85137550425
SN - 2047-9980
VL - 11
SP - e026587
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 17
M1 - e026587
ER -