Alexander C Falkentoft1, Bochra Zareini2, Julie Andersen3, Charlotte Wichmand1, Tina B Hansen1,4, Christian Selmer5, Morten Schou2, Peter Haulund Gæde6, Peter Bisgaard Staehr7, Mark A Hlatky8, Christian Torp-Pedersen9,10, Gunnar H Gislason2,3, Thomas Alexander Gerds3,11, Niels E Bruun1,12, Anne-Christine Ruwald1,2. 1. Department of Cardiology, Zealand University Hospital, University of Copenhagen, Sygehusvej 10, 4000 Roskilde, Denmark. 2. Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Gentofte, Denmark. 3. The Danish Heart Foundation, Copenhagen, Denmark. 4. Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. 5. Department of Endocrinology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark. 6. Department of Endocrinology, Regional Hospital, Slagelse, Denmark. 7. Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark. 8. Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. 9. Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark. 10. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. 11. Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 12. Departments of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen and Aalborg Universities, Denmark.
Abstract
AIMS: The association between socioeconomic position and cardiovascular disease has not been well studied in patients with type 2 diabetes. We aimed to examine the association between socioeconomic position and first-time major adverse cardiovascular events (MACE) in patients with type 2 diabetes. METHODS AND RESULTS: Through the Danish nationwide registers, we identified all residents with newly diagnosed type 2 diabetes between 2012 and 2017. Based on sex-stratified multivariable cause-specific Cox regression models, we calculated the standardized absolute 5-year risk of the composite outcome of first-time myocardial infarction, stroke, or cardiovascular mortality (MACE) according to income quartiles. A total of 57 106 patients with type 2 diabetes were included. During 155 989 person years, first-time MACE occurred in 2139 patients. Among both men and women, income was inversely associated with the standardized absolute 5-year risk of MACE. In men, the 5-year risk of MACE increased from 5.7% [95% confidence interval (CI) 4.9-6.5] in the highest income quartile to 9.3% (CI 8.3-10.2) in the lowest income group, with a risk difference of 3.5% (CI 2.4-4.7). In women, the risk of MACE increased from 4.2% (CI 3.4-5.0) to 6.1% (CI 5.2-7.0) according to income level, with a risk difference of 1.9% (CI 0.8-2.9). CONCLUSION: Despite free access to medical care in Denmark, low-socioeconomic position was associated with a higher 5-year risk of first-time MACE in patients with incident type 2 diabetes. Our results suggest prevention strategies could be developed specifically for patients with low-socioeconomic position.
AIMS: The association between socioeconomic position and cardiovascular disease has not been well studied in patients with type 2 diabetes. We aimed to examine the association between socioeconomic position and first-time major adverse cardiovascular events (MACE) in patients with type 2 diabetes. METHODS AND RESULTS: Through the Danish nationwide registers, we identified all residents with newly diagnosed type 2 diabetes between 2012 and 2017. Based on sex-stratified multivariable cause-specific Cox regression models, we calculated the standardized absolute 5-year risk of the composite outcome of first-time myocardial infarction, stroke, or cardiovascular mortality (MACE) according to income quartiles. A total of 57 106 patients with type 2 diabetes were included. During 155 989 person years, first-time MACE occurred in 2139 patients. Among both men and women, income was inversely associated with the standardized absolute 5-year risk of MACE. In men, the 5-year risk of MACE increased from 5.7% [95% confidence interval (CI) 4.9-6.5] in the highest income quartile to 9.3% (CI 8.3-10.2) in the lowest income group, with a risk difference of 3.5% (CI 2.4-4.7). In women, the risk of MACE increased from 4.2% (CI 3.4-5.0) to 6.1% (CI 5.2-7.0) according to income level, with a risk difference of 1.9% (CI 0.8-2.9). CONCLUSION: Despite free access to medical care in Denmark, low-socioeconomic position was associated with a higher 5-year risk of first-time MACE in patients with incident type 2 diabetes. Our results suggest prevention strategies could be developed specifically for patients with low-socioeconomic position.
Authors: Alexander C Falkentoft; Julie Andersen; Mariam Elmegaard Malik; Christian Selmer; Peter Haulund Gæde; Peter Bisgaard Staehr; Mark A Hlatky; Emil Fosbøl; Lars Køber; Christian Torp-Pedersen; Gunnar H Gislason; Thomas Alexander Gerds; Morten Schou; Niels E Bruun; Anne-Christine Ruwald Journal: Lancet Reg Health Eur Date: 2022-01-25