IN a new eye-opening study, from Seoul St Mary’s Hospital at The Catholic University of Korea, researchers have highlighted a link between socioeconomic status and cardiovascular mortality. Those in the lowest socioeconomic status bracket reportedly appeared twice as likely to die of cardiovascular disease (CVD) than those with higher income brackets.
“In the United States, approximately 18.1 million people have survived cancer as of January 2022.3 5 In Korea, the 5-year relative survival rates for cancer patients are at 70%” stated Mi-Hyang Jung, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. As explained by Jung, this rise in survivorship requires long-term care of these individuals as other complications, such as CVD can arise.
To better understand this relationship, Jung et al conducted a population-based cohort study, comprising 170,555 cancer survivors (mean age: 60.7 ±11.9 years). Data was taken from the Korean National Health Insurance Service (NHIS) – National Health Examinee database. For this study, they focused specifically on those diagnosed with cancer between 2002-2005 and survived by the index date of 1st of January 2011. Those with incomplete health records, or those with pre-existing CVD at the time of health check-ups as well as those deceased by the index date were excluded from analysis.
The data collection included age, sex, behavioural aspects (e.g. smoking status, physical activity, age, sex) as well as CVD risk factors (e.g. diabetes presence, body mass index) for example. Regarding socioeconomic status, household income was the main determinant of this for this study. The cohort population was divided into five groups; the lowest, comprising medical beneficiaries, and four groups of health insurance income quartiles (NHIS Q1, NHIS Q2, NHIS Q3, NHIS Q4, and medical aid, 17 from highest to lowest). Overall, the primary outcome was deaths from any CVD, spanning from January 1st 2011 to December 31st 2018.
Over a median of 8.0 years of follow-up, 2,725 cases of CVD occurred. Interestingly, there was a notable increase in CVD mortality across the different socioeconomic groups, with the highest CVD mortality found in the lowest bracket. In comparison to the NHIS Q1 group, considered the highest SES category, the adjusted HR (95% CI) for NHIS Q2, Q3, Q4, and the medical aid group were 1.15 (1.04-18 1.26), 1.28 (1.15-1.44), 1.31 (1.18-1.46), and 2.13 (1.30-3.49), respectively, after controlling for various factors, including age, sex, and conventional CVD risk factors. These findings signify a significant association between CVD mortality risk and socioeconomic status.
Helena Bradbury, EMJ
Reference
Jung MH et al. Socioeconomic status and cardiovascular mortality in over 170,000 cancer survivors. Eur Heart J Qual Care Clin Outcomes. 2024:qcae055.
