The burden of inequity: Income related disparities in cardiovascular risk factors in Europe

To assess intercountry differences in social inequities related to cardiovascular risk factors across European countries in 2020.

Observational, cross-sectional study.

We analyzed data from the European Health Interview Survey (EHIS 3) (2018-2020) across 31 European countries. Focusing on adults over 40, with a sample of 248,420 participants. Socioeconomic position was assessed by net equivalised monthly income, analyzing six cardiovascular risk factors: dyslipidemia, diabetes, high blood pressure, obesity, smoking, and sedentary lifestyle. Descriptive analyses, prevalence estimation along with Poisson regression models and relative inequity indexes (RII) for quantification of health inequity among groups were calculated, considering survey weights.

Significant geographical heterogeneity in prevalence and inequity indexes of all cardiovascular risk factors throughout Europe were found. Income presents a linear dose-response relationship with the prevalence of these factors (maximum for Diabetes, High blood pressure and Sedentary lifestyle), revealing some positive and inverse inequities (deviating from expected social gradient). Maximum gender disparity was found for Diabetes in women (RII = 2.265 [95 % CI]: 2.427-2.838) versus Men (RII = 1.785 [95 % CI]: 1.653-1.928) and inverse inequity (RII<1) for smoking habits in Bulgaria, Lithuania, Portugal and Romania.

This study highlighted significant income-related inequities in cardiovascular risk factors, with lower-income individuals exhibiting higher prevalence of dyslipidemia, diabetes, high blood pressure, obesity, smoking, and sedentary lifestyle. Country-specific variations were noted, with some countries experiencing a greater inequity, while others showed less pronounced inequity or even inverse inequalities. These findings highlight the need for equity-oriented healthcare services to reduce cardiovascular disease burden and address significant socioeconomic disparities.