Loss of CVD-free life expectancy associated with cardiovascular disease onset, stratified by age, sex, socioeconomic position and ethnicity: A nationwide population-based study
S Bijkerk, S H J Hageman, I J de Groot, I Vaartjes, F L J Visseren, Y Koop, J A N DorresteijnAbstract
Background
Although risks following a first cardiovascular disease (CVD) event are well documented, less is known about the loss of total and CVD-free life-years after CVD onset.
Purpose
To quantify the effect of a first CVD hospitalization on subsequent CVD events and mortality in subgroups of age, sex, socioeconomic position (SEP) and ethnicity, and thereby identify populations disproportionately affected.
Methods
Using nationwide data from Statistics Netherlands and Dutch Hospital Data, we identified individuals aged 18–80 years with a first CVD event between 2005 and 2013. Each individual was matched on year of birth and sex to up to four individuals without prior CVD from the general population. Subgroups were defined by age at CVD onset (45–54, 55–64, 65–74, and 75–80 years), sex, disposable household income quintiles (proxy for SEP), and ethnicity (country of birth). Differences in total and CVD-free life expectancy between individuals with incident CVD and those without prior CVD were estimated within subgroups using Kaplan–Meier methods with age as the underlying time scale, accounting for non-CVD mortality as competing risks. Cox proportional hazards models were used to estimate hazard ratios (HRs) for recurrent CVD events and mortality comparing individuals with CVD onset to those without prior CVD, subgroup differences were assessed in stratified analyses.
Results
A total of 385,096 individuals with incident CVD were matched to 1,524,399 individuals without prior CVD. Loss in CVD-free life expectancy associated with CVD onset was greater at younger ages (16.0 years at 45–54 years vs. 4.6 years at 75–80 years, see Figure 1), in women compared with men (17.0 vs. 13.0 years), and in lower compared with higher income groups (15.8 years in income quintile Q1 vs. 11.6 years in Q5). Individuals of non-Dutch ethnicity experienced larger losses in CVD-free life expectancy than native Dutch individuals. Relative risks of CVD events showed similar subgroup patterns. Individuals with incident CVD had an higher risk of subsequent CVD events compared to matched individuals without prior CVD (HR 2.66, 95% CI 2.64–2.68). This difference was larger in women (3.20, 95% CI 3.16–3.24), individuals aged 45–54 years (4.33, 95% CI 4.23–4.43), the lowest income quintile (2.76, 95% CI 2.71–2.81), and most non-native ethnic groups, indicating that CVD-patients within these groups are disproportionately affected (see Figure 2).
Conclusion(s)
Individuals with CVD onset have higher risks of CVD events compared with those without prior CVD. The impact of CVD onset differs across sociodemographic subgroups and is greater in younger individuals, women, socioeconomically disadvantaged individuals, and non-native populations. These findings underscore the importance of secondary prevention strategies to mitigate disparities in cardiovascular outcomes across populations.Loss of CVD event-free life expectancy by ageRisks of CVD events stratified by subgroups