| Title: | Sex differences in the association of social determinants of health and adverse cardiovascular outcomes in patients with atrial fibrillation |
| Journal: | Open Heart |
| Published: | 1 Jul 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41448845/ |
| DOI: | https://doi.org/10.1136/openhrt-2025-003732 |
| URL: | http://dx.doi.org/10.1136/openhrt-2025-003732 |
Publication 16907
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Abstract
BACKGROUND: Despite anticoagulation, patients with atrial fibrillation (AF) experience persistent elevated cardiovascular risk, with conflicting evidence regarding sex-based outcome disparities. Social determinants of health (SDOH)-encompassing economic, psychosocial and environmental factors-demonstrate robust associations with cardiovascular outcomes and exhibit significant sex-specific patterns, yet remain understudied in AF populations. This study aimed to clarify sex differences in the association of SDOH and adverse cardiovascular outcomes in patients with AF.</p>
METHODS: Data came from the UK Biobank. Participants with AF enrolled between 2006 and 2010 were included. SDOH comprised economic, psychosocial and neighbourhood environmental factors. The primary outcome was a composite of major adverse cardiovascular events (ie, stroke/transient ischaemic attack, arterial thromboembolic events, myocardial infarction and cardiovascular mortality) and all-cause mortality. Sex-stratified, Cox proportional hazards models were used.</p>
RESULTS: Among 3842 participants (mean age 62.5±6.1 years; 35.1% female), males demonstrated higher adverse outcome event rates than females (29.1% vs 21.3%) over median 11.6-year follow-up. Multivariate analyses revealed independent SDOH associations with adverse outcomes, with distinct sex-specific patterns. In male participants, low income (HR 1.30, 95% CI 1.08 to 1.55), unemployment (HR 1.28, 95% CI 1.06 to 1.55), living alone (HR 1.29, 95% CI 1.07 to 1.55) and housing insecurity (HR 1.26, 95% CI 1.01 to 1.57) were associated with adverse outcomes, while emotional distress was the only predictor (HR 1.33, 95% CI 1.04 to 1.69) in females.</p>
CONCLUSIONS: SDOH demonstrate sex-specific associations with adverse cardiovascular outcomes in AF populations. Integration of SDOH into risk prediction algorithms may enhance cardiovascular risk stratification and inform targeted intervention strategies in AF management.</p>
15 Keywords
- Aged
- Atrial Fibrillation
- Female
- Follow-Up Studies
- Health Status Disparities
- Humans
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Sex Factors
- Social Determinants of Health
- United Kingdom
5 Authors
- Yusheng Zhou
- Jonathan Houle
- Valeria Raparelli
- Colleen M Norris
- Louise Pilote
1 Application
| Application ID | Title |
|---|---|
| 45551 | Mechanistic modelling of neurodevelopment, neuroplasticity, and neurodegeneration |
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