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Observational Study
. 2019 Oct;49(10):1244-1251.
doi: 10.1111/imj.14214.

Association between socioeconomic status and incident atrial fibrillation

Satish Ramkumar  1   2   3 , Ayame Ochi  4 , Hong Yang  4 , Nitesh Nerlekar  1   3 , Nicholas D'Elia  1 , Elizabeth L Potter  1   2 , Isabella C Murray  4 , Nishee Nattraj  4 , Ying Wang  4 , Thomas H Marwick  1   2   4
Affiliations
Observational Study

Association between socioeconomic status and incident atrial fibrillation

Satish Ramkumar et al. Intern Med J. 2019 Oct.

Abstract

Background: Low socioeconomic status is associated with cardiovascular diseases, and an association with atrial fibrillation (AF) could guide screening.

Aim: To investigate if indices of advantage/disadvantage (IAD), index of education/occupation (IEO) and index of economic resources were associated with incident AF, independent of risk factors and cardiac function.

Methods: We studied community-based participants aged ≥65 years with AF risk factors (n = 379, age 70 ± 4 years, 45% men). The CHARGE-AF score (a well validated AF risk score) was used to assess 5-year risk of developing AF. Participants also had baseline echocardiograms. IAD, IEO and index of economic resources were obtained from the 2011 Socio-Economic Indexes for Areas score, in which higher decile ranks indicate more advantaged areas. Patients were followed up for incident AF (median 21 (range 5-31) months), with AF diagnosed by clinical review, including 12-lead electrocardiogram (ECG), as well as single-lead portable ECG monitoring used to record 60 s ECG tracings five times/day for 1 week. Cox proportional hazards models were used to assess the association between socioeconomic status and incident AF.

Results: Subjects with AF (n = 50, 13%) were more likely to be male (64 vs 42%, P = 0.003) and had higher CHARGE-AF score (median 7.1% (5.2-12.8%) vs 5.3% (3.3-8.6%), P < 0.001). Areas with lower socioeconomic status (IAD and IEO) had a higher risk of incident AF independent of LV function and CHARGE-AF score (hazard ratio for IAD 1.16, 95% confidence interval 1.05-1.29, P = 0.005 and hazard ratio for IEO 1.18, 95% confidence interval 1.07-1.30, P = 0.001).

Conclusion: Regional socioeconomic status is associated with risk of incident AF, independent of LV function and clinical risk. This association might permit better regional targeting of prevention.

Keywords: atrial fibrillation; screening; socioeconomic status.

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