The burden of premature coronary heart disease among adults with low socioeconomic status in Argentina: A modeling study

Abstract

Background

The well-established inverse relationship between socioeconomic status (SES) and risk of developing coronary heart disease (CHD) cannot be explained solely by differences in traditional risk factors. Objective

To model the role SES plays in the burden of premature CHD in Argentina. Materials and methods

We used the Cardiovascular Disease Policy Model-Argentina to project incident CHD events and mortality in low and high-SES Argentinean adults 35 to 64 years of age from 2015 to 2024. Using data from the 2018 National Risk Factor Survey, we defined low SES as not finishing high-school and/or reporting a household income in quintiles 1 or 2. We designed simulations to apportion CHD outcomes in low SES adults to: (1) differences in the prevalence of traditional risk factors between low and high SES adults; (2) nontraditional risk associated with low SES status; (3) preventable events if risk factors were improved to ideal levels; and (4) underlying age- and sex-based risk. Results

56% of Argentina´s 35- to 64-year-old population has low SES. Both high and low SES groups have poor control of traditional risk factors. Compared with high SES population, low SES population had nearly 2-fold higher rates of incident CHD and CHD deaths per 10 000 person-years (incident CHD: men 80.8 [95%CI 76.6–84.9] vs 42.9 [95%CI 37.4–48.1], women 39.0 [95%CI 36.-41.2] vs 18.6 [95%CI 16.3–20.9]; CHD deaths: men 10.0 [95%CI 9.5–10.5] vs 6.0 [95%CI 5.6–6.4], women 3.2 [95%CI 3.0–3.4] vs 1.8 [95%CI 1.7–1.9]). Nontraditional low SES risk accounts for 73.5% and 70.4% of the event rate gap between SES levels for incident CHD and CHD mortality rates, respectively. Discussion

CHD prevention policies in Argentina should address contextual aspects linked to SES, such as access to education or healthcare, and should also aim to implement known clinical strategies to achieve better control of CHD risk factors in all socioeconomic levels.