Association of socioeconomic status and life's essential 8 with cardiovascular diseases and all-cause mortality in north China: Kailuan study

Abstract

Background: We aimed to explore the association of socioeconomic status (SES) and life's essential 8 (LE8) with cardiovascular disease (CVD) and all-cause mortality in north China.

Methods: A total of 91,365 adults from the Kailuan study were included in this study. Comprehensive individual SES, mainly including monthly household income, education, Occupation position, and community environment, was confirmed by latent class analysis. Furthermore, the mediation and combination effects of SES and LE8 on CVD and all-cause mortality were further assessed. The Cox regression model was conducted to estimate HRs and 95% CI.

Results: During about 13 years of follow-up, 7,646 cardiovascular events and 11,749 deaths were recorded. Relative to the high SES, there were decreased risks of CVD [HR (95% CI): 1.57(1.43-1.72)] and high all-cause death [HR (95% CI): 1.43(1.31-1.53)] in the low SES. The associations between SES and CVD [Mediation % (95% CI): 22.3 (16.4-30.4)] and mortality [Mediation % (95% CI): 10.1 (7.1-14.0)] were partially mediated by LE8 when comparing medium SES to high SES. Meanwhile, relative to high LE8, the elevated risk of death [HR (95% CI): 1.72(1.56-1.89)], and incident CVD [HR (95% CI): 3.34(2.91-3.83)] were detected in low LE8. Compared to participants who had the high SES and LE8, participants who had both the low SES and LE8 further increased the risk of CVD [HR (95% CI): 7.76(5.21-11.55)] and all-cause mortality [HR (95% CI): 2.80(2.19-3.58)].

Conclusion: Low SES was related to a higher risk of CVD and mortality in low- and middle-income countries, which was partially mediated by LE8.

Keywords: All-cause mortality; Cardiovascular diseases; Life’s essential 8; Low- and middle-income countries; Socioeconomic status.

Fig. 1

Flow chart for the analysis of the association between SES, LE8 with cardiovascular disease and all-cause mortality. A total of 101,510 active and retired workers participated in the 2006–2007 health examination. Excluding those with incomplete income, education, occupation, community environment, and LE8 metrics. history of cardiovascular disease and cancer, 91,365 participants were included in the statistical analysis. The participants were followed until December 31, 2020. A total of 11,749 all-cause death, 7,646 cardiovascular events, 6,223 strokes, and 1,629 myocardial infarctions occurred

Fig. 2

Associations of LE8 score with All-cause mortality and CVDs (including stroke, CI, CH, and MI) by SES. HRs were adjusted for age, sex, drinking, sedentary, snoring, atrial fibrillation, congestive heart failure, fatty liver disease, and family history of diseases at baseline. Multiplicative interaction was evaluated using HRs for the product term between the LE8 score (Low versus High) and SES (low versus high), and the CI did not include 1 was statistically significant. Additive interaction was evaluated using RERI between the LE8 score (Low versus High) and SES (low versus high), and the CI did not include 0 was statistically significant