Cumulative social disadvantage and cardiovascular disease burden and mortality

Omar Hahad, Donya A. Gilan, Julian Chalabi, Sadeer Al-Kindi, Alexander K. Schuster, Felix Wicke, Matthias Büttner, Oliver Tüscher, Karl J. Lackner, Peter R. Galle, Stavros Konstantinides, Andreas Daiber, Philipp S. Wild, Thomas Münzel

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


AIMS: To investigate the association between cumulative social disadvantage and cardiovascular burden and mortality in a large cohort of the general population.

METHODS AND RESULTS: Cross-sectional (n = 15 010, aged 35 to 74 years, baseline investigation period 2007 to 2012) and longitudinal data (5- and 10-year follow-ups from 2012 to 2022) from the Gutenberg Health Study were used to investigate the association between individual socioeconomic status (SES, measured via a validated questionnaire) and cardiovascular disease (CVD, composite of atrial fibrillation, coronary artery disease, myocardial infarction, stroke, chronic heart failure, peripheral artery disease, and/or venous thromboembolism) risk and mortality. Subjects with prevalent CVD had a lower SES sum score, as well as lower education, occupation, and household net-income scores (all P < 0.0001). Logistic regression analysis showed that a low SES (vs. high, defined by validated cut-offs) was associated with 19% higher odds of prevalent CVD [odds ratio (OR) 1.19, 95% CI 1.01; 1.40] in the fully adjusted model. At 5-year follow-up, low SES was associated with both increased cardiovascular [hazard ratio (HR) 5.36, 2.24; 12.82] and all-cause mortality (HR 2.23, 1.51; 3.31). At 10-year follow-up, low SES was associated with a 68% higher risk of incident CVD (OR 1.68, 1.12; 2.47) as well as 86% higher all-cause mortality (HR 1.86, 1.55; 2.24). In general, the education and occupation scores were stronger related to risk of CVD and death than the household net-income score. Low SES was estimated to account for 451.45 disability-adjusted life years per 1000 people (years lived with disability 373.41/1000 and years of life lost 78.03/1000) and an incidence rate of 11 CVD cases and 3.47 CVD deaths per 1000 people per year. The population attributable fraction for CVD incidence after 5 years was 4% due to low SES.

CONCLUSION: Despite universal healthcare access, cumulative social disadvantage remains associated with higher risk of CVD and mortality. Dimensions of education and occupation, but not household net income, are associated with outcomes of interest.

Original languageEnglish (US)
Pages (from-to)40-48
Number of pages9
JournalEuropean Journal of Preventive Cardiology
Issue number1
StatePublished - Jan 1 2024


  • Cardiovascular disease
  • Cumulative social disadvantage
  • Disability-adjusted life years
  • Education
  • Income
  • Mortality
  • Occupation
  • Socioeconomic status
  • Cross-Sectional Studies
  • Humans
  • Risk Factors
  • Social Class
  • Myocardial Infarction
  • Cardiovascular Diseases/diagnosis

ASJC Scopus subject areas

  • Epidemiology
  • Cardiology and Cardiovascular Medicine


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