Combined Effect of Genetic Predisposition and Socioeconomic Deprivation on Atrial Fibrillation Risk

The association between socioeconomic deprivation and atrial fibrillation (AF) remains debated, with limited evidence on its interaction with genetic predisposition. We aimed to evaluate the combined effect of socioeconomic deprivation and genetic risk on incident AF.

Participants without prior AF from the UK Biobank were included. Socioeconomic deprivation was defined as the top 5% of the Index of Multiple Deprivation (IMD). Genetic risk was assessed using a polygenic risk score (PRS) for AF. The primary outcome was incident AF. Findings were replicated in an independent South Korean cohort.

Among 425,423 participants (mean age 56.5±8.1 years; 45.2% male), 21,264 were in the deprived group. The deprived group was younger and had more comorbidities. AF incidence was higher in the deprived vs. non-deprived group (incidence rate 5.8 vs. 4.7/1,000 person-years; adjusted hazard ratio (aHR) 1.16 [95% CI 1.09-1.24], P<0.001). Most IMD components (except housing and living environment) were linked to increased AF risk (aHR ranging from 1.13 to 1.19). Deprivation had a stronger effect in those with low genetic risk (lowest PRS tertile: aHR 1.36 [1.19-1.56]) compared to those with high genetic risk (highest PRS tertile: aHR 1.11 [1.01-1.22]; interaction P=0.0013). Results were consistent in the Korean cohort (n=7,898).

Socioeconomically deprived individuals have a significantly higher risk of AF, with this risk further influenced by genetic predisposition. Targeted public health policies and personalized AF screening for high-risk groups may help lessen the burden of AF and improve cardiovascular health.