title: Socioeconomic deprivation and the incidence of 12 cardiovascular diseases in 1.9 million women and men: implications for risk prediction and prevention.
abstract: BACKGROUND
  Recent experimental evidence suggests that socioeconomic characteristics of neighbourhoods influence cardiovascular health, but observational studies which examine deprivation across a wide range of cardiovascular diseases (CVDs) are lacking.
  
  
  METHODS
  Record-linkage cohort study of 1.93 million people to examine the association between small-area socioeconomic deprivation and 12 CVDs. Health records covered primary care, hospital admissions, a myocardial infarction registry and cause-specific mortality in England (CALIBER). Patients were aged ≥30 years and were initially free of CVD. Cox proportional hazard models stratified by general practice were used.
  
  
  RESULTS
  During a median follow-up of 5.5 years 114,859 people had one of 12 initial CVD presentations. In women the hazards of all CVDs except abdominal aortic aneurysm increased linearly with higher small-area socioeconomic deprivation (adjusted HR for most vs. least deprived ranged from 1.05, 95%CI 0.83-1.32 for abdominal aortic aneurysm to 1.55, 95%CI 1.42-1.70 for heart failure; I2 = 81.9%, τ2 = 0.01). In men heterogeneity was higher (HR ranged from 0.89, 95%CI 0.75-1.06 for cardiac arrest to 1.85, 95%CI 1.67-2.04 for peripheral arterial disease; I2 = 96.0%, τ2 = 0.06) and no association was observed with stable angina, sudden cardiac death, subarachnoid haemorrhage, transient ischaemic attack and abdominal aortic aneurysm. Lifetime risk difference between least and most deprived quintiles was most marked for peripheral arterial disease in women (4.3% least deprived, 5.8% most deprived) and men (4.6% least deprived, 7.8% in most deprived); but it was small or negligible for sudden cardiac death, transient ischaemic attack, abdominal aortic aneurysm and ischaemic and intracerebral haemorrhage, in both women and men.
  
  
  CONCLUSIONS
  Associations of small-area socioeconomic deprivation with 12 types of CVDs were heterogeneous, and in men absent for several diseases. Findings suggest that policies to reduce deprivation may impact more strongly on heart failure and peripheral arterial disease, and might be more effective in women.
authors.affiliation: Department of Epidemiology and Public Health and Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
authors.forename: Mar
authors.initials: M
authors.lastname: Pujades-Rodriguez
authors.affiliation: National Institute for Health Research Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, London, United Kingdom.
authors.forename: Adam
authors.initials: A
authors.lastname: Timmis
authors.affiliation: Department of Epidemiology and Public Health and Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Stogiannis
authors.affiliation: Department of Epidemiology and Public Health and Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
authors.forename: Eleni
authors.initials: E
authors.lastname: Rapsomaniki
authors.affiliation: Department of Epidemiology and Public Health and Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
authors.forename: Spiros
authors.initials: S
authors.lastname: Denaxas
authors.affiliation: Department of Epidemiology and Public Health and Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
authors.forename: Anoop
authors.initials: A
authors.lastname: Shah
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, Bristol, United Kingdom.
authors.forename: Gene
authors.initials: G
authors.lastname: Feder
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimaki
authors.affiliation: Department of Epidemiology and Public Health and Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors