Socioeconomic deprivation: an important, largely unrecognized risk factor in primary prevention of cardiovascular disease
Open accessAbstract
Background: Socioeconomic deprivation is associated with higher cardiovascular morbidity and mortality. Whether deprivation status should be incorporated in more cardiovascular risk estimation scores remains unclear. This study evaluates how socioeconomic deprivation status affects the performance of 3 primary prevention cardiovascular risk scores. Methods: The Generation Scotland Scottish Family Health Study was used to evaluate the performance of 3 cardiovascular risk scores with (ASSIGN [Assessing cardiovascular risk using SIGN (Scottish Intercollegiate Guidelines Network) guidelines to ASSIGN preventive treatment]) and without (SCORE2 [Systematic Coronary Risk Evaluation 2 algorithm], Pooled Cohort Equations) socioeconomic deprivation as a covariate in the risk prediction model. Deprivation was defined by Scottish Index of Multiple Deprivation score. The predicted 10-year risk was evaluated against the observed event rate for the cardiovascular outcome of each risk score. The comparison was made across 3 groups defined by the deprivation index score consisting of group 1 defined as most deprived, group 3 defined as least deprived, and group 2, which consisted of individuals in the middle deprivation categories. Results: The study population consisted of 15 506 individuals (60.0% female, median age of 51). Across the population, 1808 (12%) individuals were assigned to group 1 (most deprived), 8119 (52%) to group 2, and 4708 (30%) to group 3 (least deprived), and 871 (6%) individuals had a missing deprivation score. Risk scores based on models that did not include deprivation status significantly under predicted risk in the most deprived (6.43% observed versus 4.63% predicted for SCORE2 [ P =0.001] and 6.69% observed versus 4.66% predicted for Pooled Cohort Equations [ P <0.001]). Both risk scores also significantly overpredicted the risk in the least deprived group (3.97% observed versus 4.72% predicted for SCORE2 [ P =0.007] and 4.22% observed versus 4.85% predicted for Pooled Cohort Equations [ P =0.028]). In contrast, no significant difference was demonstrated in the observed versus predicted risk when using the ASSIGN risk score, which included socioeconomic deprivation status in the risk model. Conclusions: Socioeconomic status is a largely unrecognized risk factor in primary prevention of cardiovascular disease. Risk scores that exclude socioeconomic deprivation as a covariate under- and overestimate the risk in the most and least deprived individuals, respectively. This study highlights the importance of incorporating socioeconomic deprivation status in risk estimation systems to ultimately reduce inequalities in health care provision for cardiovascular disease.
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The American Heart Association's PREVENT Equations use a social deprivation index to recognize the impact that social deprivation can have on cardiovascular-kidney-metabolic conditions.
“The American Heart Association’s PREVENT Equations use a social deprivation index to recognize the impact that social deprivation can have on cardiovascular-kidney-metabolic conditions [96,99].”
From Bias in medical AI: Implications for clinical decision-making (2024) · cites this paper as [99]
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The Impact of Social Deprivation on Outcomes in Forefoot Surgery
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- Authors
- Kimenai, D. M., Pirondini, L., Gregson, J., Prieto, D., Pocock, S. J., Perel, P., Hamilton, T., Welsh, P., Campbell, A., Porteous, D. J., Hayward, C., Sattar, N., Mills, N. L., & Shah, A. S. V.
- Affiliations
- British Heart Foundation Centre for Cardiovascular Science (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Department of Non-communicable Disease Epidemiology (D.P., P.P., A.S.V.S.), London School of Hygiene & Tropical Medicine, United Kingdom.
- University of Glasgow (GB)
- University of Edinburgh (GB)
- MRC Human Genetics Unit (GB)
- Corresponding author
- Shah, Anoop S.V.
- ORCID
- Venue
- Circulation
- Published
- 2022-07-19
- Volume
- 146
- Issue
- 3
- Pages
- 240-248
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC9287096
- OpenAlex
- W4283447493
- Cited by
- 76
- References
- 38
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 22 · 2023: 22 · 2022: 1
- FWCI
- 15.01
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Circulation (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- Wellcome Trust
- Scottish Government
- British Heart Foundation (RG/20/10/34966, CH /F/21/90010, FS/19/17/34172, RE/18/5/34216)
- Department of Health and Social Care
- Scottish Funding Council
- Public Health Agency
- Chief Scientist Office, Scottish Government Health and Social Care Directorate
- Medical Research Council (MC_UU_00007/10)
- Engineering and Physical Sciences Research Council
- Economic and Social Research Council
- Health and Social Care Research and Development Division
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- socioeconomic deprivation, cardiovascular risk score, primary prevention, cardiovascular risk prediction, SCORE2, Pooled Cohort Equations, Scottish Index of Multiple Deprivation, cardiovascular events, Generation Scotland: Scottish Family Health Study, cardiovascular morbidity and mortality, health disparities
- MeSH terms
- Cardiovascular Diseases, Female, Humans, Male, Primary Prevention, Risk Factors, Social Class, Socioeconomic Factors, Cohort Studies
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