The relation between socioeconomic status and societal development with cardiovascular disease - A systematic review...

While socioeconomic status (SES) is recognized as a significant determinant of cardiovascular disease (CVD), the strength and direction of this association vary across studies and with stages of societal development. This meta-analysis of global data aimed to evaluate the relationship between SES domains and CVD outcome while examining the influence of measures on country-level for social development.

The PubMed database was systematically searched for studies published between January 2000 and October 2024, investigating associations between SES domain (income, education, and occupation) and cardiovascular outcome, including stroke and myocardial infarction. The analysis incorporated macro-level determinants, including the Gini index, global quality infrastructure index, median age, and life expectancy. Multivariate meta-regression models was used to account for effect size dependencies, and heterogeneity was assessed using I² statistics. The systematic review and meta-analysis was pre-registered at http://www.crd.york.ac.uk (registration number: 651376).

The analysis included 50 studies encompassing >7 million individuals with some degree of overlap. Education showed the strongest association with CVD outcomes (β = 0.40, 95%CI [0.37; 0.43], p < 0.0001), followed by occupation (β = 0.30, 95%CI [0.23; 0.38], p < 0.0001), income (β = 0.27, 95%CI [0.23; 0.30], p < 0.0001) and the composite score of SES domains (β = 0.17, 95%CI [0.14; 0.19], p = p < 0.0001). In multivariable analysis of country-level measures for social development, Gini index, median age and global quality infrastructure index emerged as significant interactors with the relation of socioeconomic inequalities with presence of CVD, while life expectancy did not. Substantial heterogeneity was observed across studies (I² ranging from 81.5% to 96.7%).

Among SES domains, educational attainment demonstrates the most robust association with cardiovascular outcomes. The influence of societal development on country-level on the relation of socioeconomic inequalities with cardiovascular disease underscores the importance of considering multiple societal factors simultaneously. These findings suggest that measures targeting educational access and comprehensive societal development are crucial for reducing cardiovascular health inequalities.