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Published on: April 9, 2014
Association Between Life-Course Social and Racial Inequities and the Incidence of Major ECG Abnormalities in the
Alenice Aliane Fonseca1, Lidyane V Camelo1, Enrico Antônio Colosimo2
1Postgraduate Program in Public Health, Department of Preventive and Social Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. (A.A.F., L.V.C., L.G., S.M.B., A.L.P.R.).
Background:
It remains unclear whether social determinants contribute to major ECG abnormalities (MEA), an early marker of cardiovascular disease, which predicts adverse cardiovascular events and mortality. We investigated the incidence of MEA and its associations with race and life-course socioeconomic position, as well as gender differences.
Methods:
This prospective cohort study included 11 761 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil [Estudo Longitudinal de Saúde do Adulto-Brasil]) free of MEA and cardiovascular disease at baseline (2008-2010). Incident MEA cases were identified by ECG at the second (2012-2014) and third (2017-2019) cohort visits. Explanatory variables included life-course socioeconomic position (childhood, youth, and adulthood); intergenerational social mobility; and race, and racial discrimination. Parametric survival models with interval censoring and Weibull distribution stratified by gender were used.
Results:
The mean age was 51 years (SD±8), and 55.5% of participants were women. The cumulative incidence of MEA was 15.8% in 8 years follow-up. Low childhood socioeconomic position (versus high socioeconomic position) was associated with a 48% higher incidence of MEA (95% CI, 1.17-1.87), only among women. In adulthood, low income and educational level were associated with a higher incidence of MEA in both genders, whereas occupational variables were associated only among women. Social immobility at the base of the educational and socio-occupational hierarchy was associated with an increase of 25% (95% CI, 1.04-1.49) and 31% (95% CI, 1.08-1.61) in the MEA incidence, respectively, only among women. MEA incidence was 35% higher (95% CI, 1.13-1.61) among Black women (versus White women). Furthermore, lifetime exposure to racial discrimination was associated with a higher incidence of MEA among both Black women (hazard ratio, 1.37 [95% CI, 1.04-1.82]) and Brown women (hazard ratio, 1.70 [95% CI, 1.07-2.70]). These associations were not observed among men.
Conclusions:
Life-course social and racial inequalities are associated with MEA incidence, particularly among women, underscoring the importance of social determinants in cardiovascular health.
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