Inequalities by Income in the Prevalence of Cardiovascular Disease and Its Risk Factors in the Adult Population of Catalonia

Pricila H. Mullachery, Emili Vela, Montse Cleries, Josep Comin-Colet, Khurram Nasir, Ana V. Diez Roux, Miguel Cainzos-Achirica, Josepa Mauri, Usama Bilal

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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.

Original languageEnglish (US)
Article numbere026587
Pages (from-to)e026587
JournalJournal of the American Heart Association
Issue number17
StatePublished - Sep 6 2022


  • cardiovascular disease
  • health disparities
  • health equity
  • income
  • socioeconomic status
  • Heart Failure/epidemiology
  • Diabetes Mellitus/epidemiology
  • Prevalence
  • Prospective Studies
  • Cardiovascular Diseases/epidemiology
  • Humans
  • Middle Aged
  • Risk Factors
  • Income
  • Obesity/epidemiology
  • Male
  • Socioeconomic Factors
  • Adult
  • Female
  • Spain/epidemiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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