Socioeconomic deprivation and sudden cardiac death: insights from the UK biobank
J M Choi, T M Rhee, J H Kim, S M Han, K Y Lee, H J Ahn, S R Lee, S Oh, G Y H Lip, E K ChoiAbstract
Background/Introduction
Sudden cardiac death (SCD) accounts for a substantial proportion of cardiovascular mortality, yet its relationship with socioeconomic status remains underexplored in large population-based settings.
Purpose
To investigate the impact of socioeconomic deprivation on the risk of incident SCD and ventricular tachycardia/fibrillation (VT/VF) in a large prospective cohort.
Methods
We analyzed 500,877 UK Biobank participants without a prior history of SCD, ventricular arrhythmias, or implantable cardioverter-defibrillator insertion. Socioeconomic status was assessed using the Townsend Deprivation Index (TDI) and categorized into tertiles (low, middle, high). The primary outcome was incident SCD; the secondary outcome was incident VT/VF. Multivariable Cox proportional hazards models were applied to estimate associations, with sequential adjustment for demographic, lifestyle, and clinical comorbidities during a mean follow-up of 13.5 ± 2.1 years.
Results
The mean age was 56.5 ± 8.1 years, and 45.5% were men. During follow-up, 3,041 SCD events (incidence rate 0.45 per 1,000 person-years) and 2,203 VT/VF events occurred. A graded association was observed, with survival progressively lower across higher deprivation groups (log-rank P <0.001). In the fully adjusted model, compared to the low TDI group, the high TDI group had a 24% higher risk of SCD (HR: 1.24; 95% CI: 1.11-1.37) and an 18% higher risk of VT/VF (HR: 1.18; 95% CI: 1.05-1.34). Age-stratified analyses suggested overall deprivation was more pronounced among younger adults (≤50 years) with SCD, while income-related gradients were more prominent in older adults. A significant interaction was found with smoking (P-for-interaction=0.033), with the excess risk from deprivation markedly amplified among current smokers.
Conclusion
Socioeconomic deprivation, indexed by the TDI, was independently associated with an increased risk of SCD and VT/VF. These findings emphasize the importance of incorporating social determinants into SCD risk assessment frameworks and implementing targeted prevention strategies for disadvantaged populations.