Abstract 15416: High Neighbourhood-Level Material Deprivation is Associated With Increased Rates of Cardiovascular Outcomes in Patients With ASCVD: A Population-Based Cohort Study

Background: Disparities in atherosclerotic cardiovascular disease (ASCVD) may persist even in jurisdictions with universal health care. The aim of this study was to examine the relationship between material deprivation and cardiovascular (CV) events in a population with established ASCVD.

Methods: This population-based cohort study identified individuals in Ontario, Canada ≥66 years old as of January 1, 2019, with an ASCVD event in the prior 10 years. The primary exposure was neighbourhood-level material deprivation, denoting the inability to attain basic material needs, categorized into quintiles, from Q1 (least deprived) to Q5 (most deprived). Cause-specific hazard models estimated the association between material deprivation and CV outcomes over 3 years, adjusted for baseline characteristics. Trend tests across deprivation quintiles were performed.

Results: Among 195,742 individuals with established ASCVD (median age 76 years, 37.3% female), individuals in the most deprived neighbourhoods (Q5) had higher rates of co-morbid conditions and CV disease, including myocardial infarction (MI), angina, peripheral artery disease, and coronary artery bypass grafts, compared to those in the least deprived neighbourhoods (Q1). Q5 residents had higher hazards of the composite outcome of all-cause death, MI, or stroke (hazard ratio [HR], 1.20 [95% CI, 1.16-1.24]), and component outcomes: all-cause death (HR, 1.23 [95% CI, 1.19-1.28]), MI (HR, 1.20 [95% CI, 1.11-1.31]), stroke (HR, 1.13 [95% CI, 1.03-1.23]), and heart failure (HR, 1.22 [95% CI, 1.16-1.28]), compared to Q1 residents. There were no significant differences for Q5 versus Q1 for coronary revascularization (HR, 0.97 [95% CI, 0.90-1.04]). We observed a progressive increase in risk across each quintile of deprivation (P-trend <0.05 for all outcomes).

Conclusion: Despite universal health care, increasing deprivation was independently associated with higher rates of CV outcomes.