Neighborhood-Level Material Resources and Risk of Cardiovascular Events in Patients With Atherosclerotic...

Disparities in atherosclerotic cardiovascular disease (ASCVD) outcomes may persist despite universal health care. We examined the association among neighbourhood-level material resources, cardiovascular outcomes, and medication discontinuation among patients with established ASCVD.

In this population-based cohort study using administrative data from Ontario, Canada (2019 to 2021), we included adults aged ≥ 66 years with ASCVD events in the previous 10 years. The exposure was neighbourhood-level material resources (quintiles; Q1 = most, Q5 = least). The primary outcome was a composite of all-cause death, myocardial infarction (MI), or stroke. Secondary outcomes included individual components; heart failure (HF); coronary revascularization; and discontinuation of statins, ezetimibe, sodium-glucose cotransporter-2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1RA).

Among 195,742 individuals, those in the least resources neighbourhoods (Q5) had higher hazards of the composite outcome (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.16-1.23) and all-cause death (HR, 1.23; 95% CI, 1.18-1.27) compared with Q1, with similar patterns observed for MI, stroke, and HF. Q5 residents also had higher hazards of discontinuation of statins (HR, 1.13; 95% CI, 1.03-1.24), ezetimibe (HR, 1.26; 95% CI, 1.07-1.49), SGLT2i (HR, 1.20; 95% CI, 1.05-1.37), and GLP-1RA (HR, 1.14; 95% CI, 1.01-1.29).

Despite universal health care, lower neighbourhood-level material resources were independently associated with higher rates of cardiovascular outcomes and medication discontinuation among older adults with ASCVD, highlighting persistent inequities in secondary prevention.