Neighborhood Income and Atherosclerotic Burden on Coronary CT Angiography

Socioeconomic disparities influence cardiovascular outcomes, yet their relationship with imaging-defined coronary atherosclerosis on coronary CT angiography (CCTA) is not fully understood. We evaluated whether neighborhood-level income and other sociodemographic factors independently predict atherosclerotic burden in a contemporary CCTA population.

We conducted a retrospective cross-sectional analysis of adults aged 40-79 years undergoing CCTA at a tertiary academic center from 2015 to 2024. Primary outcomes were coronary artery calcium and obstructive coronary artery disease, defined as Coronary Artery Disease-Reporting and Data System (CAD-RADS ≥3). A secondary comparator was 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk category. Primary exposures included census tract-level median household income and race/ethnicity. Ordinal and logistic regression models were sequentially adjusted for demographic, socioeconomic, and clinical risk factors.

Among 1,171 participants, lower household income was independently associated with higher ASCVD risk category and greater imaging-defined atherosclerotic burden. Compared with individuals residing in census tracts with median income ≥$150,000, those in areas with income <$50,000 had approximately twofold higher odds of obstructive coronary artery disease after full adjustment. Associations between race/ethnicity and imaging outcomes were substantially attenuated after adjustment for income and clinical risk factors, although residual associations persisted for ASCVD risk category.

Neighborhood socioeconomic context is independently associated with imaging-defined atherosclerotic burden on coronary CT angiography. Incorporation of socioeconomic indicators may improve cardiovascular risk assessment beyond traditional clinical risk factors.